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Receiv~l by:. <br />Da~e: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br />ELECTR~..AL FERI~I' APPUCA31ON <br />Please comp~ete all Sect~ns, 1through5 <br /> <br />)CONIRACrOR ~Sl'ALLA'I1C~N ONLY <br /> <br />Property Owner <br /> <br />Contractor's Board Reg, No.~7~/5 Job No <br /> <br />Si nature';i ~'t~"'~rvtsin I ~? I ' <br /> <br />2B. FO~ OI,'R~=R ~TALLA'Tt0NS <br /> <br />Property Owner <br /> <br />Mailing Address <br /> <br />City/State/Zip <br /> <br />The Installstion is being made on property I own whioh is not intended tot sale. <br /> <br /> 220 High Sa'e~ NE <br /> Salem, Oregon 97301 <br /> <br />Phone 588-5147 8:00 ~_m. - 4:30 p,m. <br />FAX: 588-7948 <br /> <br />Issued by: <br /> <br />3. PI.~N REVIEW SEC11ON <br /> Check appropriate item and en~r fee ~n E~on SB. <br /> <br />4, FEE SCHEDULE (Complete and enter total in A1 below) <br />Number of Inspections per permit allowed <br /> <br />A. Re~ldentlel, Slngleor Eems x ~t; T~[ <br />~l~-Famlly ~ ~lllng unit <br /> <br /> 15~.ft, er~ __ ~ ~. ~ <br /> E~h ~'1 ~0 ~, fl, ~ posen S 15. <br /> E~h Mfg.'d Ho~ or Modula~ ~ ~ <br /> <br /> ~er ~ ~s et I0~ vol~ (~ 4B) <br /> <br /> Oce=imult ~ $ ~. ~ <br /> <br /> E~hs~noroutlinel~hang ~ $ ~, ~ <br /> Sign~ cimuit(s) or s ~t~ ene~ <br /> <br />F. E~ ~d'l in=~on <br /> ~er ~ Nl~e In ~y of <br /> <br /> P~kofl01~els~$5.~e~ ~ $ ~. ~ <br /> <br />___ Connected Load over 200 amps (except single family dwellings) <br />., Building system Over 200 amps (except single family dwellings) <br /> System over 600 volts <br /> _ BuiJding over 2 sto~s <br /> _ B~ilding over 10,000 square feet <br />-- Occupant lead over 300 persons <br />__ Manuf~"tured Dqam]ling Perk/P, eoreation Park <br />__ Hazardous bx;atldne <br /> <br />Submit 2 sets of plens wi~ any of the above. <br />Temp~orary construction services do not apply, <br /> <br />At, Enter total of fees from <br />A~., Add5% surcflarge (.05xA1) <br /> <br />B. Enter 25% of line A1 ~ Plan Review <br />(Sec. 3), if required $. <br />O. Inveslig~tiee Fee (if required) $. <br />D. Reinspe~on Fee ($25,00) $, <br /> <br /> TOTAL AMOUNT DUE $ <br /> <br />SubtataJ $, <br /> <br /> <br />