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OFRCE USE ONLY <br />Received by: <br />Date: <br /> <br />ELECTRICAL PERI)~I' APPLICATION <br />P/ease (:orn/3bte a# Sectk)ns, 1 ~ 5 <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> 220 High Gat)et NE <br /> Satem,-Omg~n 97301 <br /> <br /> Phone s88-5147 8.00 a,m. - 4:30 p,m, <br /> <br /> FAX; 588-7948 <br /> <br />FOR OWNER ~TALLAI)ONS <br /> <br />Property Owner <br /> <br />Mailing Address J Phone <br /> <br />Owner's Signe ure <br /> <br />4. FEE ~""I-IEDULE (Comptote and entel' total in A~ betow) <br /> <br />A. Residential, Single er Items ~{ C.~st -- T~tel <br />Multi-Family per dweltll~g urllt <br /> <br /> Each M~,ad Ho~ or Modular <br /> <br />(10 ~ ~r~= I~ud~) <br /> <br /> 1O0a~or~ <br /> 101~s~ <br /> <br /> ~ a~ ~ 10~ <br /> R~nn~ Only <br /> <br />~, A~e~ er ~ <br /> 2oo a~ or le~ <br /> 201~~ <br /> ~l~s~ <br /> ~er ~ ~s or 10~ vol~ (S~ 4B) <br /> <br />E. Ml~le~ous <br /> <br /> E~h pu~ or Ir~gaUon <br /> Each ~n ~ outline li~h~ng <br /> Sign~ cl~uit(s) or a limi~ <br /> <br /> ~e ~e, Per In~on <br /> <br />H. <br /> <br /> $8.6. <br />~$15. -- <br /> <br />$130, -- <br /> <br />~$40. 2 <br />,,, $ 80. 2 <br /> <br />$ 35,, ~ 2 <br />~ $ ,50,, 2 <br />$ 15. 2 <br /> <br />__$36. .,, 2 <br /> <br />~$36 2 <br /> <br />3. PLAN REVIEW SECIION <br /> Check appropria~ item ~ enter fee in ~ction 5ii <br /> <br />.,, Connected Load over 200 amps (except single family dwellings) <br /> <br />~ Building system over 200 amps (except single family dwelilngs) <br /> <br />~ System over 600 wits <br /> Bu'~tding over 2 stories <br /> Building OVer 10,000 Scluem feet <br /> Oo~upant leed over 300 persons <br /> <br />~ Manufa~umd Dwelling Park/Reereation Park <br /> <br />__ Hazardous Loce6ons <br /> <br />Submit 2 sets of plans with any M tho above, <br />Temporary can$1~cllon sewices do not a~. <br /> <br />A~. Enter ton of fees from Sec,, <br />A~, Add ~% ~rcherge (,05 x <br /> <br /> Subtotal <br /> <br />B. Enter :~5% ~ line Al for Plan Review <br /> (Sec~ 3), if refluired <br />C. Invesagaliofl Fee (il required) <br />O. P,e~spe~on Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br /> <br />$ <br />$ <br /> <br />$ <br /> <br /> <br />