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by: <br /> <br />MARION COUNTY BUILDING INSPECTION <br />22o H~ Slmet NE <br /> S~er~ Oregon 97301 <br /> PhOne 588--5147 B;O0 a.m, - 4:30 p.m. <br /> FAX: 588-7948 <br /> <br />ELECTRICAL PERMIT APPLICATION <br /> <br />Permit No, <br /> <br />Pease oomp~te afl Sect=ns, 1 ~ ,5 <br /> <br />1. J..(3~A13ON OF IN~TALLA'RON <br /> <br />Jebkddse~s 80'74 Mil 1 Cre~k Pd S~ <br />City Aum~ville I c~=,= st. <br /> <br />Description: Installed a new heating circuit, <br /> <br />and receptacle circuit for the upstairs. <br /> <br />M,i,.~Address 1390 13th Street SE <br /> <br />Property Owner ~erz'i~ <br /> <br />Contra=toPs License NO, 24-18C <br />contractor's n~rd Rog. ,o. 3460~ I Job ,o. ~487~ ~ <br /> <br />2B. FOR OWNER I~STAU. P.'I~X~S <br /> <br />Property Owner <br /> <br />The lnstallatio~ is being made on property I OWn which Js not intended for aale, <br /> <br />Owner*s SIgnatuFe <br /> <br />lings) <br /> <br />Iseued by: <br /> <br />4. FEE SCHEDULE (Complete a~d enter teteJ in A1 below) <br /> <br />Number of Inepe=Uons per ~lt ~11~ <br /> / <br /> <br />Mulfl,~mlly ~r d~lllng unit <br /> <br /> 15~,ft,~la~ $ ~. ~ 4 <br /> E~h a~'l ~ ~, ~, ~ po~n <br /> E~h Mig,'d Ho~ or M~u~r <br /> D~lli~ ~ or ~r ~ $ ~. ~ 2 <br /> <br />( 10 ~ ~r~ ~) <br /> <br /> 101~~ ~ $ ~, ~ 2 <br /> <br /> ~1a~10~ ~ $t30. ~ 2 <br /> ~er l~O~or~l~ ~ ~, 2 <br /> R~nn~ Only <br /> <br /> ~1~~ ~ $ ~, 2 <br /> ~l~te~ ~ $ ~. 2 <br /> <br /> ~e ~m~ ~ $ ~. ~ 2 <br /> Two~ndrml= ~ $ ~- ~0 2 <br /> E~h~d*l~nglmui~orpo~on ~ $ 15. ~ 2 <br /> <br />(~ ~ F~ not <br />E~hpu~J~a~onwcle ~ $ ~. ~ 2 <br />E~h s~n or ou~ine lighang <br />S~nN cimult(s) ct a IJ~l~ enemy <br />~el.a~em~n~on ~ $ ~. 2 <br />F, ~oh add'l <br />~et ~ ~l~$1e In a~y of <br />~e ~e, pet In~n <br /> <br />O. MI~t In~lleflon ~la <br /> P~k of I0 I~ ~ $5.~ e~h <br /> (Sold only ~ el~l ~) <br />~ ~er <br /> <br />At. Enter a:~al of fees from *Sec. $4 <br />Az Adc15% sumharge (.05xA1) <br /> <br /> Sub~otal <br /> <br />B, Ente~ 25% of line At fo~ Plan Review <br /> (Sec, 3), if required <br />C. Inves§ga/ion Fee (if required) <br />D. Relnspec~on Fee ($~5.C0) <br /> <br /> TOTAL AMOUNT DUE <br /> <br />$ SO.O0 <br /> <br /> <br />