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~ . ~ MARION COUNTY BUILDING iNSPECTION <br />FOR OI~FICE USE ONLY <br />Received by: 220 High Street NE ~ <br /> <br />Date' --- -- Salem, (~'egon 97301 ...t~a~t~ <br /> ................... <br />Please complete all Sections, t oug 5 Is~g~ -, <br />....... ' ..... 7- <br /> I. LOCA'I ?ON OF IN~ALLATION ~ I 4. FE~DULE (~m~ele ~d eh,er total in A1 beinw) <br /> 5 'EGg ;J Iv I Nvmber of l.sp~hons per perm,t aflowed ~ <br /> <br />P EI~..MITS AR15 NON-'I?..ANSFERAB LE AND NON-REFUNDABLE AND <br />EXPII~.E IF WORK IS NOT STARTED wrl'~nq 180 DAYS OF ISSUANCE <br />OR iF WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A, CONTRACTOR INSTALLATION ONLY <br /> <br />Conm, clor's Boaed Reg. No. 3 5 "7 ~;S't.~ I Yob No. <br /> <br />S,,pervNoraIJcenscNo. I J '3S-~ ~4PhOn~NO' <br /> <br />FOR OWNER INS'FALLKriONS <br />Pro{>eay Owner <br />Ma~g Address Phone <br /> <br />Ctiy/St ate/Zip <br /> <br />'lq~e installation i~ being made on proper~y I own which is not intended for sa~, <br /> <br />Owner's Signalum .. <br /> <br />3. I LAN RIp, VIEW ShC i'ION <br /> <br />Wc will provide plan review service if you complete Section <br />5B alld submit two (2) sets of plans and specifications with <br />this application. <br /> <br />This optional plan review program does not suspend the <br />required submission of lighting power calculations, plans, <br /> <br />Specialty C(xte, Cha <br /> <br /> $85,00 __ d <br /> 10130 sq. fi. or in~s <br />Each additional 500 ~q. ft. <br />or porfi~ thereof $15.00 <br />Lirdited Energy $20.00 -- 1 <br />E~h Manufld Home or Modular <br />Dwelling Service or Feeder $40.00 __ 9 <br /> <br />B- $~rviees or Feeders (Does not inlcode branch ¢;rcugs. see section D) <br /> Installation, AReratlons or Rdoentlon <br /> 50.00 <br /> 200 amps or less { ~60.00 ~5~¢e 2 <br /> 220I amps to400ampa __ __ 2 <br /> 401 amps to 600 amps $100.00 __ 2 <br /> 601 amq:ra to 11300 amps $~0.00 __ 2 <br /> Over 1000 amps or volts __ $800.00 __ 2 <br /> Reconnect only -- $40.00 __ 2 <br /> <br />C. Temporary $ervice.dff~ders <br />Installation~ Alteration, or Relocalion <br />200 amps or less $~5.00 __ 2 <br />201 amps w 400 amps $40.00 __ 2 <br />401 amps to 600 amps $80.00 __ 2 <br />Owr 600 amps or 1000 vol~s <br /> <br />D, llraneh Circuits <br /> New, Alteration, or Extension Per Panel <br /> <br /> a) Th~ fee. for branch ¢im~ts with <br /> Durehase of ~ervlc~ or feeder fee <br /> Each bfa~eh circuit ~ $9.00 ~ <br /> b) 'lhe fee for branch clrculs wBhqpt <br /> purchase of service or feeder fee <br /> <br /> First branch circuit $35.00 <br /> Each additional branch cimuJ.t $2.00 <br /> <br />E. Mi$eeltaneou$ ($ervin~ or Feeder Nut Included) <br /> Each pump or irrigatJ, on circle __ $40.00 2 <br /> Each sign or outline lighting $40.00 . .. 2 <br /> Signal circuit(s) or a limited energy <br /> panel, alteration or exl:ensior~ __ $40.00 2 <br /> <br />F. Each additional Inspection <br />OVer the allowable/n any of the <br />slx)ye, p¢r .~sp~caon $85.00 <br /> <br /> G. Minor Installation Labels <br /> Pack of 10 la}~]* @ $5.00 each $S0.00 <br /> (sold only to alaetrlcal eontraetor.9) <br /> <br />H. Other <br /> (AS req-;red by Building Official) <br /> <br />5. FEES <br /> A 1, Enter total of 1~¢s f~om 80c. #4 $ ~.',,~, ©0 <br /> A2. Add 5% surcharge (.05 x Al) $ ~ <br /> <br /> Subtotal $ ~4, ~)_ <br /> <br /> g. Enter 25% of line A 1 for Plan Review <br /> (Sec. 3), if required ~ $ <br /> C, InvestigationFee (d required) $ <br /> <br /> $ <br /> <br />MC 15-34 11/9l *t No, <br /> <br /> <br />