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MARION COUNTY BUILDING INSPECTION <br /> OFRCE L~E ONLY <br /> Received by: /? /~ ,~,- ~ High Street NE <br /> Date:__ It,~ ~/ Salem, Oregon 97301 <br /> <br /> ,, ~L/C.' ~,~ v Phone588~147 8:00a.m.-4:30p.m. <br />.................................... ~ .C~ ced.-~-Pho.e: <br /> -- -- FAX: 588-7948 ~' SITE <br /> <br /> ELECTRICAL PERMIT APPLICATION / ~ts: <br /> <br /> \,~ /- <br /> 1. LOCA11C. PN OF INS~rALLATION <br /> <br /> Directions: <br /> <br />Property Owner <br /> <br />Contractor's License No. '~ ~,2,, ~;~" <br />Oontractor's Board Rog, No..~-,~ ~ r~._7 IJob No. <br /> <br />2B. FOROWNER II~rALLA110NS <br /> <br />Property Owner <br />Mailln~ Address <br /> <br />Phone <br /> <br />Olty/Smto/Zlp <br /> <br />The [nero, fiction ia being made on property I own which is not in,eroded for tale. <br /> <br />Owner's Slgnatum <br /> <br />4. FEE SCHEDULE (Complete and enter total in A~ below) <br />Number of Inspections per permit eltewed <br /> <br />A. Residential. Single or Items x Cost <br />Mule-FamilYrserviceinc, luded)1500 sq. fl. or tssGper dwelling unit -- $ 85. <br />Eachadd'lSOoq. fl. orpordon -- $ 15. <br />Eesh M fg.'d Home or Modular <br />Dwelling sen. io~ or teeder __ $ <br /> <br /> 401 ampete6~0amps -- $ 80. <br /> 601ampere 100Oan~ps __ $130. __ <br /> Over 1000 amps or volto __ $300. <br /> Racennest Only __ $ <br /> <br />c. Temporary $ervloes/Fesders <br /> <br /> 200 amps or less -- $ 35. __ 2 <br /> 2olempete4ooamp~ __ $ 40. __ <br /> 401 amps to 600 amps $ ~0.._~_~ 2 <br /> Over 600 crepe or I000 VOltS (See 4B) <br /> <br />O. Brenoh Clreulte % JV- <br /> <br />Oneelmull ~ ~ $ 35. 2 <br />Two to ten dn:uits ~ $ S0. 2 <br />Eeshadd'lten~imuitsorportJon __ $ 15. __ <br />E. Mlecellaneoue <br />($etv/ce ~,' Feeder nor <br />,~'~chpumpoHrrtgationcyole -- $ 3G. -- <br />Eachs~gnoroutlinel~ghtJng __ $ 36. __ <br /> .~igna] ¢itoult(s) or a limited energy <br /> <br />F. Each eddq inspec~den <br />over the allowable in any of <br />lheabove, perlnspeetJon __ $ 35. __ <br /> <br />Pankofl01abels@$5.00each $ 50, -- <br />(Sold only to elan~cal contractor~) <br />I'L Other <br />(A= required by Building Official) <br /> <br />PI.,.AN REVIEW S~ <br /> Check apprepria~ item and enter fee in S6c'~n 5~ <br /> <br /> Connected ~ over 200 amps (except single family dwellings) <br />__ nuilding system over 200 amps (except single family dwellings) <br /> System over 600 volts <br />-- Building ever 2 stories <br />__ Building over 10,0oo square feet <br />__ CXx~upent lead over 300 persons <br />__ Manufa~umd Dwelling Pa~k/Rea~adon Park <br /> Haza'dous Locations <br /> <br />Submit 2 sets of plans wi~ any of ~e ebove. <br />Temporary conet~cflon services do not apply. <br /> <br />MC f5-34 Rev. 7/90 <br /> <br />A~, Enter total of fees from Sec. <br />Ae. Add5% sumha~ge (,OSxAt) <br /> <br /> Subtotal <br /> <br />B. Enter 25% of line At for Plan Review <br /> (Sec~ 3). if required <br />C. Inves~gadee Fee (if required) <br />D. P~nspe~on Fee ($25,00) <br /> <br /> TOTAL AMOUNT DUE <br /> <br /> <br />