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OFRCE USE ONLY <br />Received by; <br />Date: <br /> <br />ELECTRICAL PERNIT APPLICAllON <br />Please compete ~l Sa~n~ ~ ~=ugh 5 <br /> <br />MARION COUNTY BUILDING <br /> ~:)0 I-~ Street NE <br /> Salem, ~n ~1 <br /> Phone ~147 8~ ~m.-4~p.m. <br /> <br />Issued by: <br /> <br />Diteotiena: <br /> <br />Mailing Address I Phone <br /> <br />City/Stare/Zip <br /> <br />The Installation Is being made on property I own which is not Intended fei sale. <br /> <br />Owner's Signature <br /> <br />PLAN REVIEW SECTION <br /> Check ap~mp~= item and enter fee in ~c~an SB. <br /> <br /> Connected Load over 200 amps (except single family dwellings) <br />__ Bui~ng system over 200 amps (except sb, gle family dwellings) <br /> System over 600 volts <br />__ Bui(ding over 2 sto~es <br />__ Building over 10,000 ~uam feet <br /> Oceu~n~ ~ over 3~o I~rcene <br /> Manufa~ared Owe~J PadVP, ecre,;~ <br />__ Hazardous Loca~ons <br /> <br />Submit 2 sets of plans wi~ any of t~e above. <br />Temperer/censt~ctlon cervices do not al~oly. <br /> <br />4, FEE SCHEDULE (Complete end enter total in A1 be]ow) <br />Number of inspe~Uens per permit altewed <br /> <br /> 1 <br />Mul~Family per dwelling unit <br /> <br />1500~Z:L fi. or tsss ~ $ 85, 4 <br />Eachadd'lS00sq, ff. orpo~on ~ $15, __ <br />Ea~Jt Mfg/d Home or Modular <br />Dwelllngse~tce01"far~er ~ $ 35, , 2 <br />B. Servlse~eedars <br /> <br /> lO0 amps or less 2 <br /> 101 eJllps te 400 amps ~T~ $ <br /> See,__ <br /> 401amps te 600 araps __ $ 80, 2 <br /> 601 ampsto t000aml~ ~ $130. 2 <br /> Over 1000ampsorvolts ~ $300. -- <br /> Reconneot Only __ $ 35, 2 <br /> <br />C. Temperery <br /> <br /> 200 amps or less ~ $ 35. ~ 2 <br /> 20tamp~to4~oamps ~ $ 40. 2 <br /> 401 ampete600enlps $ 80, ~ 2 <br /> Over 600 amps or 1000 veils (See 4S) <br /> <br />D. Branch Clroulte <br />New. A/tem~n ~ Extorts/on Par p~nel <br />Onecli~cull ~ $ 35. , 2 <br />Two to ten circuits ~ $ 50, 2 <br />Eechadd'lten¢imuitsorporflen ~ $ 15. 2 <br /> <br />E. Mlecelleneee~ <br />($en,~e of Feedar llot /r~c.l~d~ <br />EaehpsmparkrigalJoooy=le -- $ 36, 2 <br />E~ch ~gn otouitine lighting __ $ 36. 2 <br />Signs! dmuit(s) o[ e, llmlted energy <br />panel, altera~-tetextens~on ~ $ 36. , 2 <br />F. Each edd'l leepeotlon <br /> <br />P~ckofl01abels@$$,00eech ~ $ S0. ~ <br />(So/d only to e!e~tn'cal contractors) <br />H. Other <br /> <br />A~, Enter total of fees from se=, #4 $ <br />A~, AddS% surcharge (.0exam) <br /> <br /> se~o~ <br /> <br />B, Enter 25% of line A1 for Plan Review <br /> (Sec., ~), it required <br />C. Investlgalioa Fee (if re~ired) <br />D, Reinspec~n Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br /> <br /> <br />