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OFRCE USE ONLY <br />Received by: <br />D~e: <br /> <br />MARION COUNTY BUILDING INSPECTION <br />220 High Street NE <br /> Salem, Oregon 97301 <br /> <br /> Phone 588-5147 8:00 a.m. - 4'~0 p.m. <br /> <br /> FAX: 588.7948 <br /> <br /> ELECTRICAL PERNiT APPUCA'nON <br /> Please compHte ~1Sec~ns, 1 through 5 <br /> <br />,.¢'4 I¢.m Ier°a* st' <br /> <br />SIT~: #: Permit No, <br /> <br />Iseuecl ~: <br /> <br />Description: <br /> <br />Moiling Address <br />Property Owner ~ <br />Contractor's Llcense No. ~::~T..~'~ ~.~ <br /> <br />Supervisor s ~i~nse No~ I Phone <br /> <br />2B. FOR OWNER If~TALLA'IIONS <br />I Property Owner <br /> <br />Mailing Address I Phone <br /> <br />City/State/Zig <br /> <br />The Installation Is being made on property I own which is not intended for sale. <br /> <br />Owner's Signature <br /> <br />3, PLAN REVIEW SECT1ON <br /> Check appmp~ate item and enter fee in .~lJon 5il <br /> <br />__ Connected Load over 200 amps (except single family dwellings) <br />..... Building system over 200 amps (ex.)pt single family dwellings) <br />__ System Over 600 VOI~ <br />.... Building over 2 stories <br /> BuiJding over 10,0oo squ~re feet <br /> Occupant lead over 300 psrsens <br />__ Menufactur~l Dwelling Pa~P, ea~a~on Pmk <br />__ Hazardous Locations <br /> <br />Submit ;~ sets of plans with any of the ebove. <br />Tempormy c~ms~'uofion services do not apply. <br /> <br /> 4. FEE SCHEDULE (Comp/ere and enter total in A~ below) <br /> <br /> Number of leepseflene per permit allowed <br /> / <br /> A. Resldenflal, Stegleor Items x Cost; Totel <br /> MullI-Femlly per dwelling unit <br /> (Sen4=e ~duded) <br /> t~OO~l,~Orle~e / $ es, ~ 4 <br /> ~aohaddlSOOeq. ti. erpo~on / $ 15. /~-~-~o <br /> Eech M~g.'d Home or Modular <br /> DWelling seneca or feeder __ $ 35, 2 <br /> <br /> (t 0 Branch G/rc~/ta/n~ded) <br /> Ir~m//at,bn..4/~waabr= or Re,~.aden <br /> lOOampsorle~ --. $ 35. __ 2 <br /> 10'1 an'~oete400enlps __ $ 60. __ 2 <br /> <br /> 601amps~o lO00ampe __ $130. __ 2 <br /> Ove~ 1000ampsor volts __ $~00. 2 <br /> Reconner4Only __ $ 3.5. __ 2 <br /> C. Temparary Servlee~/Feedere <br /> 200 arn~ or less __ $ 35. __ 2 <br /> :i[018mpete400amps __ $ 40. 2 <br /> 401 e~'~ te 600 arnl~ $80. -- 2 <br /> Over 600 amps or 1000 VOlts (See 4B) <br /> <br /> D. Branch Circuits <br /> New, Almretl~ or EJct, w~ion Per Panel <br /> Oneclmult __ $ 3,5., 2 <br /> Two te ten drmlts $ ~0, 2 <br /> Eaehedd'itenc~rcuit~orportlen $ 15. __ 2 <br /> <br /> F- Miscellaneous <br /> ($e~vl~e ~x, Feeder not h3cluded) <br /> Each ps mp or irrigation cycle -- $ ~ l ~ <br /> Eaehslgnoroutlinelighting __ $ 36, -- 2 <br /> Signal clmult($) or a limited energy <br /> pals/, alteration or extension __ $ 36. __ 2 <br /> F, Eegh edd'l Inspection <br /> over the allowable in any of <br /> ~le above, per Inspection -- $ ~5. -- <br /> G. Minor Installation Labele <br /> Peel{ of 10 labels @ $5.00 each -- $ <br /> ($okf on/y to a/ac~cal ~n/ractots) <br /> <br />N. <br /> (As required by Building Official) <br /> <br />At, Enter total of fees from Sec, #4 <br />~i ~ ~ ~e (.05 x Al) <br /> <br /> Subtotal <br /> <br />B. Enter 25% of line A1 for Plan Review <br /> (Sec~ 3), if required <br />C. Investigation Fee (if required) <br />D. Reinspec~n Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br /> <br />$ <br /> <br /> <br />