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Dele: <br /> <br />MARION COUNTY BUILDING INSPECTION <br />220 High Sires{ NE <br />~ Oregon 97301 <br /> <br /> Phone 588~147 8.~0 ~t.m. - 4;30 p.m. <br /> <br /> FAX: 588-7948 <br /> <br />ELECTRICAL PERr~J'r APPUCATION <br />Please cornl3tete all Sec~ns, l ff~;x~gh 5 <br /> <br />SITE ~" {_ Perm t No ~_ <br /> .I ............ <br /> <br />Issue<:l by: <br /> <br />Contra~tor'~ Bbard Reg, No.~ ~ I Job No. <br /> Phone <br /> <br /> ~ FOR OWNER I~STALLA310NS <br /> 'Property Owrle~' <br />.... Mail,nO ArJdre~ <br /> <br />Phone <br /> <br />City/sLate/Zip <br /> <br />The installation Is being made on pr'opetty I Own which ia not intended for sale, <br />lease or fem. <br /> <br /> Owner's Sl{Ina~ure <br /> <br />-- Connec~d Load ova' L:'00 amps (except single family dwellings) <br />__ I~uik~ng system over 200 amps (except shgle family dwellings) <br />__ System over 600 vo~ts <br /> JE~il~ng over 2 SIDleS <br />... I~il~ng ov~ 10,ooo squem feet <br />__ Occupant load over 300 persons <br />__ Manufamumd Dwel~ng Pa. rk/Fiecma~on Park <br />__ Hazardous locations <br /> <br />Submit 5, sets of pla~s with any of the abowa. <br />Temfxxaty co~16trtm'don se~vlee~ do not apply. <br /> <br />4. FEE SCHEDULE (Complete and enter total in ^1 below) <br />Number of Inep~ct~on~ per permit allowed <br /> <br />A. Reek~entlal, Single <br /> <br /> 1500 sq./t, o~ tess <br /> <br /> 1~ <br /> <br /> ~l~or~ <br /> <br />Item~ x Co~t = Total <br /> <br />2 <br />2 <br />2 <br />2 <br />2 <br /> <br />2 <br /> <br />2 <br /> <br />At, Ente~- total of fees from Sec. #4 <br />A2. Add 5% surcharge (.05 x At) <br /> <br /> Subtotal <br /> <br />B. Entar 25% of line At for Plan Review <br /> (Sec. 3), if required <br />C. Invesifga~on Fee (if required) <br />D. Relnspe~ion Fee ($25.0O) <br /> <br /> TOTAL AMOUNT DUE <br /> <br /> <br />