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Received by: <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> 22o High Slmet NE <br /> Sa~n~ Oregon 97301 <br /> <br /> Phone 588~5147 8.'00 a.m, - 4~0 p,m, <br /> CocOA Phone: 588-Tg04FAX; 588-7948 SITE #; lL~qbq <br /> <br />Issued by: <br /> <br />De~¢¢lptlon: <br /> <br />Property Owner <br /> <br />FOR OWI~IER INSTALLA~ <br /> <br />: Property Owner <br /> <br />Phone <br /> <br />The Ins[allat[on is being made on property I own which is not intended for sale <br /> <br />__ Buik~ng system over 200 amps (except silgte family dwellings) <br /> System Over 600 volts <br />__ Building ove~ 2 s/~es <br />__ Building over I0,Ooo squm~ feet <br />__ Occupant inad over 300 persons <br />-- Manufac~md Dwelling Pan~JP, ecmminn Park <br />-- Hazardou~ ~s <br /> <br />Submit 2 sets of plane wit~ any of lfle above, <br />Temporary con sl~m'~on services do not apply. <br /> <br />4, FEE ,~HEDULE (Complete end enter totaJ in A1 bo~ow) <br /> <br />A. Realde~tlel. Single ~ <br />MUlfl~mlly per d~lll~ unit <br /> <br /> 1~, lt,~ <br /> ~ ~'I~ ~, ff,~n <br /> E~ Mfg.'d H~ or M~ <br /> D~li~ ~ ~ f~r <br /> <br /> R~n~ ~ <br /> <br /> S~n~ ~i~it(s) or a i~ <br /> <br /> · e ~we, ~ In~n <br /> <br /> (~old on~ ~ el~l ~) <br /> <br /> 1 <br /> <br />$ ~5. <br /> <br /> $35. 2 <br /> <br />-- $130, __ 2 <br />__$300,__ 2 <br /> <br />__$35. 2 <br />__$50. 2 <br />__$15., 2 <br /> <br />__$36, $36. <br /> <br />$36, 2 <br /> <br />At, Enter total of f~es imm Sec, #4 <br />A,~.. Add 5% surc~ha,~e (.05 x A~) <br /> <br /> SubtetaJ <br /> <br />B. Enter 25% of line A~ fo~ Plan Review <br /> (Sec. ~). if re,uti'ed <br />C. invesllgadon Fee (if required) <br />D. R~inW~n F~ <br /> <br /> TOTAL AMOUNT DUE <br /> <br /> <br />