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OFRCE ~ONLY <br />Received by: <br />Date: <br /> <br /> ELECTRICAL PERNET APPMCA'RON <br /> P~ase comp/eta a//Sect/one, I through 5 <br /> <br />Job Address <br /> <br /> Cross St,, <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> ~ High Street NE <br /> Salem. Oregon 97301 <br /> <br /> Phone 588,5147 8:00 a,,m. - 4:30 p.m. <br /> Code-A-Phone:: 588-7904 SITE #: <br /> PAX: 588-7948 <br /> <br />Permit No,, <br /> <br />Iceued by:: <br /> <br />~ ~IS~rALLA~iON ONLY <br /> St. S.E. <br /> <br />Property Owner <br /> <br />Contractor's License No, <br />24-18C <br />Contractor's Board Rag No, Job No. <br /> 34604 ........... <br />m~F~_~ of svpory~i~¥,¢~. ~ ///'2 <br /> <br />Supervisor s L~eQse <br /> /,"5 <br /> <br />2B, FOR Q~NNER INSTALLA'nONS <br />Property Owner <br /> <br />Mailing Address I Phone <br /> <br />Clty/Smta/71p <br /> <br />The installation Is being made on property i own which is not intended for ~le, <br /> <br />C"~ne Fas Signature_ <br /> <br />3. PLAN REVIEW SECllON <br /> Check appmprlato item and enmr fee in <br /> <br />-- Connected Load over 200 amps (ox~ept single family dwellings) <br />__ Building system over 200 amps (except single family dwellings) <br /> System over 600 volts <br /> Building over2 stories <br />__ Building over 10,000 square foe~ <br /> Occepant load over ~00 persons <br /> Manufactured Dwelling PaddReeree~on Park <br />..... Hazardous Lacations <br /> <br />Submit 2 sets of plans with any of the -hove. <br />Temporary conem~c~on services do not apply. <br /> <br />4. FEE SCHEDULE (Complete and enter total in A~ below) <br />Number of Inspeotlons per permit allowed <br /> <br />A. Resldenttsl, Single or <br />Multi-Family per dwelling unit <br />($ervtce /nCluded) <br /> 1500 ng, fl. or le~ <br /> Each add'1500 SCl. It. or portion <br /> Each Mfg'd Home or Modular <br /> Dwelling ee~ce or feeder <br /> <br />B, Servlee/Faedera <br />(10 Branch O~r cui~e <br />Installation, Alterations or <br /> 100 amps or leas <br /> 101 a~ to 400 amps <br /> 4St amps to 600 amps <br /> 601 amp~ to 1000 aml~ <br /> Over 1000 amps or voit~ <br /> Reconnect Only <br /> <br />C. Temporary Servlees/Fe~:lers <br />Ins talla#~n, Aitera~on or RelocaEon <br /> 200 amps or <br /> 201 ampe to 400 amp~ <br /> 401 arnp~ to 600 art~>s <br /> Over 600 amps or 1000 volts (See 4B) <br /> <br />D. Branch Cimulte <br />New. Aitera~n or Exl~n~ion Per Pe~el <br /> One ~imuit <br /> Two to ten <br /> Each add'l ten circuits or portion <br /> <br />IE, Mlaeelleneee= <br />( $e,'v~e or Feeder not lnclud~l) <br /> Each pump or Irrigation cycle <br /> Each sign or outline lighting <br /> Signal cimuit(e) er a limited energy <br /> panel, alteration or extension <br /> <br />F, Ecr..h add'l inspection <br /> over the allowable In any of <br /> Thc aJ:)ovc, per in~e~tion <br /> <br />G. Minor fnstolteflen Lmbele <br /> Pack of 10 labels @ $5,,00 each <br /> (Sold only ts eleeb'ical contractor~) <br /> <br />H, Other <br /> (AS required by ~ut/ding Official) <br /> <br />items x Cost = Total <br /> $ ~s,, <br /> <br />$130. __ 2 <br /> <br />$35. 2 <br />__$40, 2 <br />__ $80.__ 2 <br /> <br />$35. 2 <br />$50. 2 <br /> <br />A~. Enter totaJ of fees from Sec,, #4 <br />A~. Add5% eercflarge (,,05xA0 <br /> <br /> Subtotal <br /> <br />B. Enter 25% of line A1 for Plan Review <br /> (.~c., 3), if required <br />C. Invesfigafim Fee (if required) <br />D. ReinspeCiion Fee ($25~00) <br /> <br />TOTAL AMOUNT DU~: <br /> <br />Reeeipt No. <br /> <br /> <br />