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ClJI Jc bty Address I Cross St. <br /> <br />MARION COUNTY BUILDING / .~ .. <br />220 I-r~jtl S~:~{~ NE <br />Salem, Oregon 973o1 (I ~'0' i ' <br />Phone ~5147 8~ a.m. - 4~0 p.m. <br /> <br />Eleotrlcal Contract~ <br /> <br />Proper~ Owne~ <br /> <br />Oontractor~ License No. <br /> <br /> n~ractor ~ Board Rag, <br /> /~ <br /> <br />SupervIsor's License No <br /> <br />2B. FOR OWNER I~b"TALLATION5 <br />Property Owner <br />Mailing Address I Phone <br />City/State/Zip <br /> <br />The Inetatlaton Is being made on property I own whioh Is not intended for sale, <br /> <br />· 3. PLAN REV1EW SL=CIION <br /> Che~k aPPtoPflate item and enter fee in S~ion 5B. <br /> <br />__ Connected Load Over 200 amps (except single family dwellings) <br /> Building syst~'n over 200 amps (except single fami¥ dwellings) <br /> System aver 600 volts <br />__ Building Over 2 stefles <br /> Building Over 10,000 m:lUam feet <br />__ Cccopant load over 300 persons <br />__ Manufactured Dwelling Pan~n Park <br />__ Hazardous Locations <br /> <br />Submit 2 sets of plans with any of the above. <br />Temporary construction services do not apply. <br /> <br />4, FEE SCHEDULE (Complete and enter total in A1 below) <br /> <br />Number of Inspections per permit allowed <br /> ! <br /> <br /> Each add'l SOo sq. ff. orportien ' $ 15. ~ ~_ 4. <br /> F-ach M~l.'d Home or Modul~ .ypj~ <br /> <br />e. Service/Feeders -"~'~' i . .,,"~../' ~."'~_ <br />(tom~~ ~ ~ ~.,~" ,-, 0 .... <br />~OOam~orleee /y~ ' . sas. ~ <br /> 101 ampete4OOeelpe ~ ' ~ $ 60, ~ 2 <br /> <br /> 401ampetsasOempe $ 80, -- 2 <br /> asl ampere lOOOamps -- $130. 2 <br /> Over 10OOamp$orvolt9 __ $300. __ <br /> RaconnectOnly -- $ as, __ 2 <br /> <br />C. Temporary <br /> <br /> 200ampeerleee __ $ as. __ 2 <br /> 201 ampste400amps __ $ 4o, __ 2 <br /> 401ampsto600amps __ $ 80. __ 2 <br /> Over as0 amps or 1000 voltS (See 48) <br /> <br />D, Branch Olmulte <br /> <br />OneeJmutl __ $ 35, <br />Two to ten c~reelts $ 50. 2 <br />F-a~hedd'ltenclmultsorporflon __ $ 15. __ 2 <br />JE, Mlecelleneous <br />(Servfcec~Feederr~t <br />E~.h pump or kdgaton cycle $ as. __ 2 <br />Eaohsigneromlinelightng __ $ as. __ 2 <br />$~Jn~1 circuit(s) or a limited energy <br />Penel. alteration or extsns~on __ $ as, __ 2 <br /> <br />me above, per InspeclJen -- $ 35. __ <br />G. Minor Installation I~bela <br />Pa=k of 10 labels @ $$.00 e~h $ <br />(sold only to el~c~lcal cenffacto~'s) <br />FL O~ner <br />(As required by Bu#ding Official) <br /> <br />Al. Enter total of fees from Sec. #4 <br />A~. Add 5% surcharge (.05 x Al) <br /> <br /> Subtotal <br /> <br />B. Enter ~ of line A~ fo~ Plan Review <br /> ~(Sec. 3), if required <br />C. Invesl~gatiee Fee (if required) <br />D. Reinspec~n Fee ($25.00) <br /> r <br /> TOTAL AMQUNT DUE <br /> <br /> <br />