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C~-'T/CE Li~E ONL¥ <br /> Received by:: .... <br />:: Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br /> 220 High S~e{ NE <br /> Sa~m, Omgon 97301 <br /> <br />Phone.588-5147 B:0Oaf¢-4;3Opm <br /> <br /> FAX: 58~-7948 <br /> <br /> FI FCTRICAL PERI~'F APPLICA'13ON <br /> P~ase temple <br /> <br />C~[y ' ' <br /> <br />Directions:: <br /> <br />Description, <br /> <br />t~ued by:: <br /> <br />4. FEE E. CHEDULI= (Complete and enter total in A1 below) <br /> <br />N <br /> <br />2A. C(~iTRACTOR ~TK~ ONLY <br />£lec~¢lcal Con,ra~ter ~. ~.. <br />M~iling Address <br /> <br />$~perv ~or"s License No, / ~ ~7 ~ S <br /> <br />lJob No <br /> <br />OWNER ~TALL~31ONS <br /> <br />Mailing Address { Phone <br /> <br />City/state/Zip <br /> <br />The installedon is being made on property I own which is no[ in[ended for sale. <br />lease Or rent <br /> <br />100 emus o~ less <br />101 ~ps to 400 ~-aps <br /> <br />E~ s~n ~ outline I~h~ng <br /> <br /> $35 -- 2 <br /> <br />$1,30. 2 <br />~ $35 ~ 2 <br /> <br />$ 15 -- 2 <br /> <br />3, PLAN REV1EW SEC'IION <br /> Ch~k appre~Wate item and eeter fee in Se:EOn SD, <br /> <br />Connected Load over 200 amps (except single family dvellings) <br />Bui~ng system over ~ amps (exoept single family dwellings) <br />System over600 volts <br />Building over2 stories <br />Building ~ 10.000 square feet <br />Ocd~pant load over 300 ¢ers~ns <br />Manufactured Dwe~llng Per. Recreation Pa~k <br />Hazardous I.~atiens <br /> <br /> Submit 2 set~ of plans with any of the above. <br />~Temporaty con¢l~cCon ¢~rvlces do not al~ly. <br /> <br />Enter to,al of fees from Sec ~4 <br />~ 5% ~ (,,O5 XA[) <br /> <br /> Subtotal <br /> <br />Bll Enter 25% of line A~ for Plan Review <br /> (Se~. 3), if [equil~ed <br />C Invesfigali~l Fee 0f reopimd) <br />o Reiaspe~on Fee ($~S,00) <br /> <br />TOTAL AMOUNT 0UE <br /> <br /> <br />