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MARION COUNTY BUILDING INSPECTION <br />220 Higff Street NE <br /> Salem, Oregon 97301 <br /> Phone 58~5147 8.00 a.m. - 4:30 p.m. <br /> <br /> FAX: 588.7948 <br /> <br />,] <br /> <br />ELECTRICAL PERI~T APPLICA~IQN <br />P,~ase ~r~c~te a//Sect/ohS, I throb. Oh 5 <br /> <br />18TAmr~ wrnm ~ DA~ °~ "~aA"c~ °m~w°~s ~r~o"" ~r~ ~m ~ I <br /> <br /> FOR OWNER tNSTALLATIOf~ <br />Propert~ Owner <br /> <br />Owner'e Signature <br /> <br />PLAN REVIEW SECllON <br />Check appropria~ item and enter <br /> <br />Connected Load oyer 200 amps (excerpt Nng~e family dwe~ngs) <br />Bui~ing sy~m ~r ~ ~ (ex.pt shgb ~ily ~lings) <br /> <br />Building ~er 2 <br />~il~ng ~ 10~ ~ ~t <br />~t ~ ~r ~ <br />~u~ ~li~ P~ P~ <br />H~us ~ns <br /> <br />Submit 2 set~ of pte~s wilh any of ~he ~bove. <br />Temporaly cons~UC, flon sewices do not apply. <br /> <br />Issued by: <br /> <br />Permit No,, <br /> <br />4, FEE ~CHEDULE (Complete and enter total in At below) <br />Number et Inspections per permit allowed <br /> <br />Multi*Family per d~,a~lllng unit <br /> <br /> 1500 ~1,, fL Ot' less <br /> Each add1 .q00 sq. fl, <br /> ~h M~,,=d HO~ or Modu~r <br /> <br />B. ~wle~e~ers <br /> <br /> l~a~ <br /> <br /> ~n~t On~ <br /> <br />D, Branch CIr~l~ <br />N~, A~ ~ E~ P~ P~I <br /> <br /> E~ pu~ or Ir~a~on ~le <br /> E~h ~n or outline Ilghang <br /> GignN ¢lmutt(=) or a limi~ e~y <br /> ~el, ai~m~ or ~ten~on <br /> <br /> · e ~¢ve, per In~aon <br /> <br />G. ~not Insmlte8on ~1~ <br /> P~k of 10 ~els ~ $5,~ ea=h <br /> <br /> (~ ~i~ by ~i~ ~) <br /> <br /> $85,__ <br />~ $ 15,, __ <br /> <br />~$15. <br /> <br />$36. . ..... <br />__. $ 36,, <br /> <br />2 <br />2 <br />2 <br /> <br />A~. Enter to~d of fees from sec. ~f,4 <br />,~.. Add S% surch~Je (,,05 x A~) <br /> <br /> SubtetaJ <br /> <br />B, Enter 25% of line A1 for Plan Review <br /> (Sec. ~, if required <br />O. Invesl~gadon Fee (if required) <br />D, Relnspecl~on Fee ($2500) <br /> <br /> TOTAL AMOUNT DUE <br /> <br />$ <br />$ <br /> <br /> <br />