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FOR OFFICE USE ONLY <br />P/ease comp~ere ~1 ~e~/ons, 1 through 5 { iss~N COUNTY <br /> <br />LOCATION OF INSTALLATION <br /> <br /> ~E NON-~S~BLE ~ NON-~AB~ ~ <br /> WORK ~ NOT ~T~ ~ 180 DAYS OF ~SU~CE <br /> WO~ I~ SUSP~DED FOR 180 DAYS, <br /> <br />2B, FOR OWNER INSTALL~.TION$ <br /> <br />Prope~ Owt~r <br /> <br />Mailing Address <br /> <br />City/~t atcf~p <br /> <br />The ~t~tal]al~on is beJfls made on pro~ I own w~Jch is Ilo~ int~n~ed for sale. <br /> <br />Ow~eis Si~vamr~ ..... <br /> <br /> PLAN REVIEW SECTION <br /> <br /> Wo will provide plan review service if you complete See~on <br /> 5B and submit two (2) sots of plans and Sl~Cffications with <br /> this application. <br /> <br />This optional plan review program docs not suspend the <br />required submission of lighting power calculations, plans, <br />and specifications when required by the Oregon Structural <br />Specialty Code, Chapter 53. <br /> <br /> 4. FEE SCHEDULE (Complete and enl~- ~olal in A I below) <br /> <br /> Num hex a~ inspections per pormlt allowed <br /> <br /> A. <br /> Per <br /> Unit <br /> <br />-- tO00 sq,-fu orloss ~ $85,00 ,,. 4 <br /> o~ pordon thereof $15,00 <br /> <br /> l~ach Mallufd ~Ioale or Modular <br /> Dw¢lllng Scrvic~ or Peed~ ~ $40.00 ~ 2 <br /> <br /> B. Servl~ or Fcedors (Do~s no[ ~nlcud~ bm~ch clrcui[~, ~ee seedon <br /> Installation, A/tm'ations or Relocation ~;'/~ /~.~ <br /> 200 am~ or less .,, $50.00 <br /> 201 em~ t~ 400 ~ups ~ $60.00 . <br /> <br /> ~ ~ps or l~ss ~ $~.00 ~ 2 <br /> <br /> 401 ~ps to ~ am~ $~.00 2 <br /> ~er ~ ~ps or 1~ vo~ <br /> <br />D, Branch Circuits <br /> Ne% Alteration, or F~xtm$1on P~r ]Panel <br /> <br />E. MIs~llan~u~ (Service or F~er Not <br />~ ~p ~ ~gafi~ ~lo <br /> Each ~ or ~e ~h~g <br /> ~8n~ ~it(s) or a ~ <br /> <br /> ~er ~ ~owable ~ any of ~e <br /> <br /> (~l~ oMy tO el~ctr~l~om~o~f <br /> <br />H. 0~ <br /> ( ~ ~q~d by ~u~i~ Offic~0 <br /> <br />$35,00 <br /> $2.00 <br /> <br />$40.00 ~ 2 <br />$40.00 2 <br /> <br />$40.00 ~ 2 <br /> <br />$35,00 <br /> <br />$~ .00 <br /> <br />s, <br /> <br /> A2. A~ 5% su~ha~e ¢05 x Al) <br /> <br /> ~b~l <br /> B, ~n~r ~% or,heAl for ~an Review <br /> <br /> D, Re~s~fi~ Fee ($~,~) <br /> <br /> ~TAL ~O~ DUE <br /> <br /> <br />