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Da~e: <br /> <br />MARION COUNTY BU. ILDING INSPECTION <br /> <br />1. LOCATtDN OF INSTALLA~DN <br />Job Ad~res~ t30~ ERRIN STREET <br />City DETROIT I Cross <br /> <br /> 220 High ~ NE <br /> Salem, Oregon 97301 <br /> <br />Phoae 588-5147 8::00 e,m, - 4:30 p,m- <br /> <br /> FAX: 588-7948 <br /> 1 <br /> <br />Issued by: <br /> <br />Description:: RECONNECT RV SERVICE <br /> <br />~ OONTI%~TOfl ~ALLAllON ONLY <br /> <br />Electric. el Contractor <br /> <br />Mailing AddreSa <br /> <br />Property Owner KATHY FISHER <br /> <br />Contraoter's Lioense No,, <br /> <br />GontfaCt0r~$ ¢~oard Rag No I ,,10b No. <br /> I <br /> <br />Signature of Supervising Electrician <br /> <br />No,, <br /> <br />28. ~ OWNER II~tSTAt. LA3~(~S <br /> <br />: Ptopeay Owner KATHY FISHER <br /> <br /> Cl~lSmtq/ZIpu <br /> ......... ~ ~ ~33ol <br /> <br />X 3,,'~ ? <br /> <br />The tns~eJlatlon is being made on property I own which ia r~ot intended for sale, <br /> OWner's Signature, ~ <br /> <br />4, FEE SCHEDULE (Complete and enter total in A1 below) <br />4umber ef Inspections per permit allowed <br /> <br />Multi-Family per dwelling unit <br /> <br /> 1500sq ftmless <br /> <br /> E~h M~g ,'d H~ or M~I~ <br /> <br /> ~ar ~ ~s ~ 10~ volts <br /> <br /> E~h s~n ~ ou~ine 5~g <br /> 5~n~ =i~it(s) or a limi~ enemy <br /> <br /> ~et ~ Nl~le In any of <br /> <br />2 <br />2 <br /> <br />2 <br />2 <br />2 <br /> <br />PLAN REVIEW SECIION <br /> Chedx appropriate item arid enter <br /> <br /> Conne~l ~ over 200 amps (except single family dwellings) <br />__ Bulking system ~ <br />., Sys~m ~r ~o ~ <br />~ Buil~ng ~er 2 <br /> ~il~ng ~ 10,~ ~uam ~t <br /> <br />~ ~u~ ~i~ng P~n <br /> H~us ~ns <br /> <br />SubnlJt ~' sets of plans wi6~ any of the above, <br />q'emporary cons~ction services do not apply. <br /> <br />At Enter total of fees from Sec. #4 <br />A3. Add 5'% sumha~ge (.05 x A~) <br /> <br />Sub~taJ <br /> <br />B. Enter 25% of line A~ fo~ Plan Review <br /> (Se~, 3), if required <br />o. Invosdga~an Fee (if required) <br />D,, Reinspection Fee ($25,00) <br /> <br />TOTAL AMOUNT DUE <br /> <br />$ 35. O0 <br /> <br />$ <br /> <br />$ 36,7.5 ........ <br /> <br /> <br />