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Date: <br /> <br />EIJF..CTRICAL PERI~.~' APPLICA'RON <br />P~ase ~omp/ate a// SeCtions, I through 5 <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> $ <br /> 220 High Street NE <br /> ,.~tem, O~egon 97301 <br /> <br /> Phone 588-5147 8~00 a~m - 4GO p,m. <br /> <br /> FAX: 588-79~8 <br /> <br />2B. FOR OWNER ~ISTALLA~ <br /> <br />Property Owner <br /> <br />City/$~atelZIp <br /> <br />The installatloft ia being made on property I own which is not Intended for sale, <br /> <br />Ownet"a Signature <br /> <br />'3. PLAN REVIEW 8E-CI1ON <br /> <br />Check app~,a'~ate Item and enter fee in Section ..qB. <br /> <br />Connected Load over 200 amps (except single family dwellings) <br />Building system over 200 amps (except single family dwellings) <br />System over 600 volts <br />Building over 2 stodes <br />Buliding over 10=000 square feet <br />Oc.~upam lead over 300 perSOns <br />Manulactumd Dwelling Pan, Recreation Pmk <br />Hazardous Locations <br /> <br />Submit 2 sets of plans with any of the above. <br />Temporary eensiruc'llan services do not apply. <br /> <br />SITE #; Permit No, <br />Da~: <br />Issued by: <br /> <br />4, FEE SCHEDULE (Complete and enter total in A1 below) <br />Humber of Inspections per permit eltawed <br /> <br />/L Residential, Single or <br />Multi-Family per dwelling unit <br /> <br /> lS~ ~ fl, er le~ <br /> ~h a~'l ~0 ~, ~. or posen <br /> E~h Mfg/d Ho~ er Modul~ <br /> D~lling ~ or f~r <br /> <br />a. <br /> <br />C. Tem~mW <br /> <br /> ~0 a~ or la~ <br /> <br />~r ~ ~s or 10~ ~1~ (S~ 4~) <br />O, Bm~h C~l~ <br /> <br /> ~h ~d'l mn elmui~ Or ps,on <br /> <br />(5~ ~ F~ not ~d) <br /> <br /> ~h =~n <br /> <br />F. Each add'l <br /> <br />G. Miner installation <br /> P~kof t0 I~b <br /> (Sold on~ te <br /> <br /> (~ ~i~ by <br /> <br />Item~ x <br /> <br />$130 <br /> <br />__$36, <br /> $36,__ <br /> <br />At, Enter tetalof fees from Sec,, ~-4 <br />Az,, Add5% sumharge (,,OSxAQ <br /> <br /> Subtotal <br /> <br />B. Enter 25%of lineAl fo~ Plan Review <br /> (Sec~ 3), it mquked <br />C, InvestigalJan Fee (if required) <br />D. Reinspe~on Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br /> <br />2 <br />2 <br />2 <br /> <br />2 <br />2 <br />2 <br /> <br />2 <br /> <br />2 <br />2 <br /> <br />2 <br /> <br /> <br />