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OFP/CE USE ONLY
<br />R~::eived by:
<br />Date:
<br />
<br />MARION COUNTY BUILDING INSPECTION
<br /> 220 High Sa'aa{ NE
<br /> ~aJem, Gegon 97301
<br /> Phone 588-5147 8:00 a,m, - 4;30 p,m,
<br />
<br /> ,,, ,,,
<br /> ~ T ~' ~Vs~ ~ ! ~OC'! issuedby:
<br />
<br /> MARION C(J,'~lt .....
<br />
<br />t~IMI~ ARE NON4'~AN~'~RABI~ ~ND NONREPUHO~BLE AND ~nE IF W(3~K 16 NOT
<br />
<br />2~, FOR OWNER ~t~ISTALL~TIO~
<br />Property Owner
<br />kts, t[Lng Address" '~ Phone
<br /> I
<br />
<br />Owner's Signature
<br />
<br />Permit No,
<br />
<br />N~ )~C1~SCHEDULE (Complete and enter totalinA~ below)
<br />
<br />A. Residential, Single or
<br />Multi-Family per dwelling unit
<br />
<br /> 1500 sq, fl,, or loss
<br /> Each addq 500 sq, fi,, or pordon
<br /> Eaoh Mfg/d Home or Modular
<br />
<br />B..5'africa/Feeders
<br />f10 ~ranch Cin~= lnduded;
<br />In,e mllatlon, Ai~ra ti=ns or Retoca#on
<br />
<br /> 101 amps te 400 amp~
<br /> 401 re'eps to ac0 amps
<br /> 601 amps to 1000 amps
<br /> Over 1000 an~s or volts
<br /> ReConnect Only
<br />
<br />C. Temporary .Servlee~/Feedere
<br />Ins~a//aebn, A/teraEon ar
<br /> 200 amp~ or tess
<br /> 201 amps to 4o0 amps
<br /> 401 amps te 600 amps
<br /> Over ~ amps or 1o00vo~ (Sae
<br />
<br />D, Branoh Circuits
<br />New, AiteraEon or Exter~on Per Panel
<br /> One elmull
<br /> Two to ten circuit,
<br /> Each add'l ten dreulto or portion
<br />
<br />E. Mtsceltsneoua
<br />($ervi~e or Feeder not in~uded)
<br /> Each pump or Irrigation cycle
<br /> Each s~gn or ouIllne fighting
<br /> Signal cbcuJt(s) o~ a '~i'ff~tsl
<br /> panel, alteration or extension
<br />
<br />F. Each add'l Inspection
<br /> over the a/IowaJ~te in any of
<br /> · e above= per inspec'~on
<br />
<br /> (Sold only to el~al cootra~ters)
<br />
<br />H. Ot~er
<br /> (,4a r~ul~d by ~ulldleg Of~cJal)
<br />
<br />$35, 2
<br />
<br />~ $60. ~
<br />~$80,
<br /> $130.
<br />__$300.
<br />~$35 ~
<br />
<br />__ $40, __ 2
<br />~ $ 80,__ 2
<br />
<br />~$15 2
<br />
<br />__. $ ,36, 2
<br />
<br />3. PLAN REV1EW S~
<br /> Check appropriate i~rn and enter f~ in Eection 5B.
<br />
<br /> Connected Load over 200 amps (except angle family dwellings)
<br />
<br />~ Building system over 200 amps (except single family dwellings)
<br /> System over 600 volts
<br />__ Building over2 stories
<br />__ Building over 10,000 ~luam leet
<br /> Ooc~pan/lead over ~00 persons
<br />__ Manufactured Dwel])ng Park/Recreation Pan~
<br /> Hazardous Locations
<br />
<br />Submit 2 sets of plans wilfl any of ~e above.
<br />Tempora~J COnsl]ructlon serv(ces cb3 eot ap~y,
<br />
<br />Al, Enter total of fees from Sam, ~r
<br />~, A~t 5% surd'e, me
<br />
<br /> Subtotal
<br />
<br />B, Errler 25% of line Al fo~ Plan Review
<br /> (~e¢. 3), if required
<br />O. Invesligation Fee (if required)
<br />D, Reinspec~iOn Fee ($2,5,00)
<br />
<br /> TOTAL AMOUNT DUE
<br />
<br />
<br />
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