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ELECTRICAL PERMIT APPUCA*I]ON <br /> P/ease oprnp/ete a// Sections, 1 t~ 5 <br /> <br />1, I.OCA'TK)N OF IN~'r~M.LA'I~3N <br /> <br />MARION COUNTY BUILDING INSPECTION <br />220 Hi, t1 $~re~ NE <br /> Salem, Oregon 97301 <br /> <br /> Phone 588-5147 8.'00 &m,, - 4~3o p.m,, <br /> O.,~18-A~°hone: 5as-79e4 SITE': I ~ I~.~ <br /> FAX: 588-7948 <br /> Date: <br /> <br /> Issued by: <br /> <br />~ C~NT1RACrOR IIMb~TALL.ATIQN ONLY <br /> <br />Eleclrlc.~l Oontmotor <br /> <br />Mailing Address <br />"~op~rty owner <br /> <br />l Job No,, <br /> <br />'~:;~ntractors 8O~,ta Rog, No,, <br /> <br />Supervisor~s Llconse No I Phone <br />2B. FOR OWNER ~STALL~TIONS <br /> <br /> & PLAN REVIEW S~ <br /> Ch~ck apPmpdate item and enter fee in Ss~Uon SB. <br /> <br /> __ Connected Load over 200 amps (exmpt single family dwellings) <br /> Building system over 200 amps (except sbgle family dwellings) <br /> __ System over 600 volts <br /> <br /> ~ Building over 2 stories <br /> <br /> ~ Building over 10,000 square feet <br />,__ Occappnt Ioed over 300 pe~on$ <br /> -- Manufac~red Dwelling Pa~JReerea~n Park <br /> __ Hazardous Leea~ons <br /> <br />Submit 2 sets of plans with any of tha a~ove. <br />Temporary ¢onel~uc~ion services do not apply, <br /> <br />Permit No, <br /> <br />4. FEE SCHEDULE (Complete and enter total in A~ below) <br />Number of InspeetJonJ per permit eltewed <br /> <br /> A. Residential, Single or <br /> Multi-Family per dwelling unit <br /> ($ew,~e/nduded) <br /> <br /> E~h Mfg*d Ho~ ot M~ular <br /> <br /> C, Tem~ ~i~e~F~ers <br /> <br /> ~er ~ ~s or 10~ volts (S~ <br /> <br /> E~h pu~ ~ irdga~n <br /> Ea~ s~n or outline lighang <br /> S~na cimult(s) or a I1~ enemy <br /> <br />F. ~eh edd'l ths~Uon <br /> over the allele in any of <br /> me ~ve= perln~aon <br /> <br />~ ~r <br /> (~ ~i~ by ~i~eg ~i~l) <br /> <br />Al. Enter total of fees from Se~. #4 <br />A2. Add5% ~rcharge (-05xAt) <br /> <br /> Subtotal <br /> <br />B. Enter 25% of line A1 for Plan Review <br /> (Sec. 3), if required <br />O. invosligatian Fee (if required) <br />D, Relnspe~On Fee ($35,00) <br /> <br /> TOTAL AMOUNT DUE <br /> <br />$ <br />$ <br />$ <br /> <br />2 <br />2 <br /> <br />2 <br />2 <br />2 <br /> <br />2 <br /> <br /> <br />