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oF~/CE USE ONLY <br />Received by: <br />Date: <br /> <br />ELECTRICAL P~RMIT APPUCA~ <br />Pease c~mp/ete a//Set,ns, 1 ~hroucS~ 5 <br /> <br />MARION COUN1-Y BUILDING INSPECTION <br /> 220 High Street NE <br /> Salem. Omgon 973O1 <br /> <br /> Phone 588-5147 8.~00 ~m. - 4"~0 p.m. <br /> Iqtoq i <br /> <br />1. LOCATiOfl OF II(FrN..LAII~N <br /> <br />Description; <br /> <br />Property C~vner <br /> <br />2~ R3R OWNER I~S'TALLA'ilON~ <br />Propert-/Owner <br /> <br />The Ins[allatlon ie being made on property 1 own which Is nol Intended foe sale, <br />lea~e ot rent. <br /> <br />4. FEE ,~H£DULE (Complete and enter te~-d In A1 below) <br />Number of tespeelionm per permit allewe~ <br /> <br />$15 .... <br /> <br />$35, 2 <br /> <br /> $35, ~ <br /> <br /> $80. 2 <br /> $130. 2 <br /> <br />__$35. 2 <br /> <br />__$40. 2 <br />__$80.__ 2 <br /> <br />$15. 2 <br /> <br />__$36. 2 <br />$36. 2 <br /> <br />$36, 2 <br /> <br />$50. <br /> <br />3. PLAN REVIEW SECI1ON <br /> Check aPproprtate item and anter fee in Sec~ SB. <br /> <br />.... Connec~cl L~ed over 200 amps (ex~pt single family dw~ling$) <br /> Building system crier 200 amp~ (except si'~gts family dwellings) <br />__ System over 600 volts <br />_, Buii~ng over 2 ste~s <br /> Buil~ng ovm 10.000 square feet <br /> Occupant load over 300 persons <br />_. Manufa~umd Dweilfng Pak/RecmatJan Pa~ <br /> H~s b3ca~ms <br /> <br /> Submit 2 sets of plans with any of the above, <br />· Temporary ~onsm.~--~on services do not apply, <br /> <br />A~. Enter toteJ of fees from Se~ ~4 <br />A2, ~ 5% s~rchaeg~ (,05 X Al) <br /> <br /> Subtotal <br /> <br />B. Enter 25% of line A1 roi' Plan Review <br /> (Se~ 3). if required <br />C. Invesfigal~n Fee (if required) <br />D. P,e~spe<~an Fee t$25.00) <br /> <br />TOTALAMOUNTDUE <br /> <br /> <br />