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Ptease comlY, ete a~ Sect~ns, l thmu~ 5 <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br /> ~ High Street NE <br /> Salem, Oregon 97301 <br />Phone 588~147 8:00 a,m. - 4:30 p.m. <br />FAX: 588-7948 <br /> <br />~escdptien: <br /> <br />~ ~ ~FI'AM..ATION ONLY <br /> <br />C~ntractor's License No, [, ~_ (..,,~:~ ~_ <br /> <br />2IL FOil OWNER 14STALLAllONS <br /> <br />Propef~Owner <br /> <br />City/State/Zip <br /> <br />The Installation is being made on property I own whJah is not intended for sale. <br /> <br />Owner's Signature <br /> <br />3. PLAN REVIEW SEC31ON <br /> Check app~o~l~ item and enter lee/n Sec#on <br /> <br /> Connected Load over 200 amps (except single family dwellings) <br />__ Building system over 200 amps (except single family dwellings) <br />__ System over 600 ~olts <br />__ Building over 2 <br /> <br />~ ~uifding over 10,000 square feet <br />__ OomJpant load over ~ peracac <br />__ Manufactured Dwelling Park/P, ecma~n Park <br />__ Hazardous LocaEons <br /> <br />Submit 2 sets of plans with any of ~e above. <br />Temporary consl~uclJon services do not apply. <br /> <br />SITE #; <br /> <br />Issued by: <br /> <br />MARION COUNI'Y <br />§UILDINU ;NSP].,L:i ~ON <br /> <br />4. FEE SCHEDULE (Oomp[em and enter total in At below) <br />Number ~ In~peetlon~ per permit allowed <br /> <br />A. Nesldentlal, Single or Immm x ce~t [] Total <br />Multi.Family per dwelling unit <br />( $ervi~e indud~t) <br />1.500 sq. lt. or te~ __ <br />Ea~hadd'lS00sq. ft. orpo~'flon __ $ 15. <br />Each Mfg.*d Home or Modular <br />Dwelling servWe or feeder __ $ 35. ~ <br /> <br />B, Servlce~Feeder~ <br />( to Brar~h ~/r~u/m <br />/n~a/laz,~n, A~era~b~ or <br />160 amps or le~ __ $ <br />101 amps te 400 amps __ $ 60. <br />401 amps to 600 emps ~ $ ~O. __ <br />601 andre lOO0amps __ $130. <br />Over 100Oampservolts ~ ~,300. -- <br />Reconnect Only ~ $ 35. __ <br /> <br />C. Temlx~rary '~e~,,lce~Feedere <br />Inslal~don, Aitera~ <br />gooampsartess -- $ 35. ~ <br />201amps m 4oO m'nps ~ $ 40, <br />40t amps~600~ ~ $ 80. <br />Over 600 amps or 1000 volts (See <br /> <br />D. Branch Clmull~ <br />Ney/, Aiteta~o~ or Extension Pe~ Pane/ <br />Oseeimsit ~ $ 35, __ <br />Two to ten ¢~roui~ __ $ 50. ~ <br />Ea~add'ltenoimuiteorportJon ~ $15. <br /> <br />E. Miscellaneous <br />(Se.vice ~v Feeder not included) <br />Each ~mp ar it~e~,~,n ~ <br />Eechsignoroutlinel[ghlleg ~ $ 36. __ <br />$igsal =imuit(s) or a limited energy <br />panal, altera~on orexmnsion -- $ ~, <br /> <br />F. Each edd'l <br />over the allowable in any of <br />~he above, per Inspac~n -- $ 35. -- <br /> <br /> Paek0fl01abels@$5.00each -- $ 50. __ <br /> (Sold oniy to electrical ~ontraatets) <br /> <br /> (AS tequinad by ~uilding Official) <br /> <br />At. Enter totalof fees from Sec. <br />A~. AddS% surcharge (.05xA~) <br /> <br /> Subtotal <br /> <br />B, Enter 25% of line Al fo~ Pla~ Review <br /> (Sec. 3). if required <br />C, Investigalio~ Fee (if required) <br />D. Relnspe~on Fee ($25.00) <br /> <br />TOTAL AMOUNT DUE <br /> <br /> <br />