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GFRCE USE OM.Y <br />Received by:,, <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br />~A. CONTRACTOR I'~I'ALLA'IX:X~ ONLY <br /> <br />2B. FOR OWNER I~"TAMA130N~ <br />PrQper~ Owner <br />Mailing Address I Phone <br />Cia/State/Zip <br /> <br />The ]ns~llatJon is being made on proper~ I own which Is not intended for sale. <br /> <br /> PLAN REVIEW SEGTIQN <br /> Check appropriate item and enaer <br /> <br /> Connected Lead over 200 amps (ex=ept single family 6wellings) <br /> <br /> ~ Building system ever 200 amps (except single family dwellings) <br /> _ System ov~r 60O vo~ts <br />__ Building over2 stenes <br /> -- ~itding over lO,C~O square feet <br />__ Occupant load over 300 persons <br />-- Manufamured Ov~,lling Pa~/P,e~'~on <br />__ Hazardous Loc~tiong <br /> <br /> 2~ High-Street NE <br /> Salem, Omgon 97301 <br /> <br />Phem~ 588-5147 8:0(3 am, - 4:30 pm <br />FAX; 588.7948 <br /> <br />Permit No, <br /> <br />Issued by: <br /> <br />4. FEE SCHEDULE (Complete and enter total in A1 belaw) <br />Humbet' of ]nep~clJon~ per permit elt{~w~l <br /> <br /> Each Mfg,=d H~ or Modular <br /> <br /> ~0 a~ ~le~ / $ ~,~ 2 <br /> ~er ~ ~s or I0~ ~lm (S~ 4B) <br /> <br /> E~hpu~orirdga~on~cle ~ $ ~. 2 <br /> 8ign~ cimdil(s) or a limi~ e~e~y <br /> <br /> · e ~e. per in~n ~ $ ~. ~ <br /> <br /> P~kofl01~$5~e~ ~ $ ~ ~ <br /> (~o~ only ~ e~l ~cm~) <br /> <br />.% <br /> Al. ;nter total of fees lmm Sec, #4 <br /> A2, Add 5% sarcha~le (.05xA0 <br /> <br /> Subtotal <br /> <br />B. Enter 25% of line A1 ~ Plan Review <br /> (Sec~ 3), if required <br />C. Investigad~ Fee (if required) <br />D Reinspec~on Fee ($25,00) <br /> <br />TOTAL AMOUNY DUE <br /> <br /> <br />