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OFF~ IEONLY <br />Received by: <br /> <br />1. LOCA~ OF iNSTALLATION <br /> <br />C~ty <br /> <br />Directions:: <br /> <br />MARION COUNTY BUiLDiNG II <br /> 220 High Street NE <br /> sabra, Oregon <br /> Phone 588-,5147 8:00 a,m,, - 4~0 p,m. <br /> -~'~'~ ! ~*i Permit No, <br /> "7'_ i f:'*i <br /> ~'~.~t0: ~C.0~J~H~DULE (CompleteandentertotalinA, <br /> Number of In~flon~ ~r ~rmR ~11~ <br /> <br />Phone <br /> <br />25. FOR OWNER <br />PraperP/Owner <br />'Mailing 'Address <br /> <br />"~tty/State/ZIp <br /> <br />Owner'a Slgnetum <br /> <br />A. Residential. Slngl® <br />MulU-Famlly per dwelling unR <br />($ervice ir~luded) <br /> 1500 ~,, fl,, <br /> E~h e~'l ~0 <br /> E~h M fg.'d Ho~ or M~ul~ <br /> ~llng <br /> <br />C. Tem~ <br /> <br /> ~er ~ <br /> <br /> ~ch ~n or outline llgh~ng <br /> Sign~ ct~it(s) or a R~t~ energy <br /> <br /> · e ~ove, ~ In~on <br /> <br />below) <br /> <br />Cost = Tol~J <br /> <br />$ 15. <br /> <br />~$35 , 2 <br /> <br />.,..~.~__ $ 35,, 2 <br />$130 ~ 2 <br /> <br />~ $80.__ 2 <br /> <br />__$35 2 <br />/ s ~o,, ~ 2 <br />__$t$, 2 <br /> <br />3. PLAN REVIEW SECTION <br /> Check applppt~ item and entel' fee in Section 5B. <br /> <br />Connected Loed over 200 amps (except single family dwellings) <br />__ Building system over 200 amps (except single family dwellings) <br />__ System over 6O0 volts <br />,, Building OVer 2 s~odes <br />,,, ~Jil~ir~ OVal' 10aO00 square feet <br />__ Occupant load over ~OO persons <br /> <br /> Hazardous Locations <br /> <br />Submit 2 sets of plans w~ any of the above, <br />Tempora,~y ¢~nsls'uctJon sewices do not app,. <br /> <br />Al. Enter tot~J of fees bom Sec, ~,4 <br />~... Add,f. ~u~harge (.05xA~) <br /> <br /> ~SubtotaJ <br /> <br />B, Enter 25% of line A1 for Plan Review <br /> (Sec. ~), ~! required <br />C. Investigation Fe~ (if required) <br />D. Reinspec~n Fee ($250O) <br /> <br /> TOTAL AMOUNT DUE <br /> <br /> <br />