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1, LOCA'nON OF INSTALLA'rION <br /> <br />JobAddress 9493 PORTER ROAD <br /> <br />MARION COUN~TY BJJILDING INSPECTION <br />220 High Street NE <br /> Salem, Oregon 97301 <br /> <br /> ~7 - 0 <br /> , P · : SIT~ #' <br /> <br /> BUZDING <br /> <br />City A U H S V I L L E { Cro,8 st,, <br /> <br />Desorlption: T E M P S E R V I C E <br /> <br />2A, OONIP, ACTOR I¢~FALLATION ONLY <br /> <br />Electrical Contra=tot F R A I"l L E R E L E C T R I C C 0 M P A N Y <br /> <br />Mai~ingAddres~ 11860 SW GREENBURG, TIGARD, OR <br /> <br />Proper~Owner M B S <br /> <br />Contraotor"s LIcense No,, 3 4 - 1 3 C <br /> <br />C0ntra~tor's Board R'eg, No, 3 7 ~ 1 0 I Job NO,, 4 9 7 1 2 <br />SJgna~ar~ of ~upervJslng Electrician <br /> <br />Supervi~or'~ License No. 1 8 1 6 ~ I Phone No, 6 3 9 - 4 6 2 7 <br /> <br /> FOR OWNER I¢~FALLA'IION~ <br />Property Owner" <br /> <br />Mailing Address I Phone <br /> I <br /> <br />The Installation is being made on property I OWn whioh Is not Intended for sale. <br />lease or rent,, <br /> <br />3. PLAN REVIEW S~ <br /> Check app~odate item and enter fee in Section SB. <br /> <br />Permit No, <br /> <br />~L'J-~ SCHEDULE (Complete and enter total in At below) <br />Number ¢~f thspe~ttons per permit allowed , <br /> <br /> A. Residential, Single or Items x Cost = Toter <br /> <br /> Multi-Family per dwelllnB unit <br /> <br /> 15CO sq, fl, ~less <br /> Bl~Gh ~al ~0 ~, fl, or posen <br /> ~ M~,,'d Ho~ or Modul~ <br /> ~lling ~ or f~r <br /> <br /> 101~4~ <br /> <br /> R~nn~ Only <br /> <br />~ Tem~m~ <br /> <br /> ~1 ~sto <br /> ~er ~ ~s or 10~ ~1~ (S~ 4B) <br />D. Bmnoh Clmul~ <br /> <br /> One cimult <br /> <br />(~ ~ F~r not ~d~) <br /> E~h pu~ or IrH~n ~le <br /> E~ s~n or outline ligh~ng <br /> SlgnN cimuit(s) or a li~t~ e~y <br /> <br /> (Sold on~ to e~Fl~l <br />~ ~er <br /> <br />__$85.__ <br /> <br />~ $~. ,i 2 <br />$130. 2 <br />__ '~300. 2 <br />$35. 2 <br /> <br />__ $~.. 35.00 e <br /> $4o,__ 2 <br /> <br />$35.__ 2 <br />__$50.__ 2 <br />__$15.__ 2 <br /> <br />2 <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 velt~ <br />__ Building over2 stories <br /> Building over 10,000 square feet <br /> Occupant load Over 300 persons <br />__ Manufactured Dwelling ParWP. ecmafion Park <br />i Hazardous Locations <br /> <br />Submit 2 sets of plans with any of the above. <br />Temporary consm~on Beryl=es do not apply. <br /> <br />Al, Enter total of fees frore Se=, #4 <br />,~.. Add 5% surahazge (,,05xA~) <br /> <br />Subtotal <br /> <br />B, Enter 85% of line At for Plan Review <br /> (8ec~ 3), if required <br />C. Investigation Fee (if required) <br />D. Relnspe~Jon Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br /> <br />$ 35.00 <br />$ 1 .75 <br /> <br />$ 36,7~ <br /> <br /> <br />