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MARION COUNTY BUILDING INSPECTION FOR OFFICE USE ONLY Received by: ~2,20 I'I~h Date: ~ ~em, ~g~ ~/~ut /]Jl~% ~e-A-~:~.~;?~ SITE ": L.OT.,OAL.E.M.T A..L,O T,ON Please complete all Se~ions, I through 5 PERMITS ARE NON-TRANSFERABLE AND NON-REFUNDABLE AND EXP/RE IF WORK IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE OR IF WORK IS SUSPF2NDED FOR 180 DAYS. 2A. CONTRACTOR INSTALLATION ONLY A. Residential Per Unit Service Included: 1000 sq. ft. or less Each additional 500 sq. ft. or pollion thereof I~nimd Energy Each Manufd Home or Modular Dwelling Se~rice or Feeder $85.OO 4 $15.00 $20.00 $40.00 B. Services or Feeders (Does not inlcude branch c~rctths, see section D) Installation, Alterations oc Rdocation 200 arnl~ or less $50.00 201 amps to 400 amps $60.00 401 amps to 600 amps $100.00 601 amps to 1000 amps $130.00 Over 1000 amps or vuits $300.00 Reeormeet only $40.00 $~.00 C. Temporary Services/Feeders Installation, Altaraflon, or Relocation --2 --2 --2 2 2 2 Mailing Address Pmpsrty Owner Con~a~oes U~s, No. ,Z,2 Contractoes Board Reg. No. ~/V,~t~ Signature of Supervising 2B. FOR OWNER INSTALLATIONS IJob No. Phone No. Property Owner Mai~g ~ddmss Phone Ci~/~t ate/Zip The installation is being made on property I own which is not intended for sale, Owner's Signature 3. PLAN REVIEW SECTION We will provide plan review service if you complete Section 5B and submit two (2) sets of plans and specifications with this application. This optional plan review program does not suspend the required submission of lighting power calculations, plans, and specifications when required by the Oregon Structural Specialty Code, Chapter 53. Over 600 amps or 1000 voks D. Branch Circuils New, Alteration, or Ext ~'lslon Per Panel a) The fee for branch circuits with purchase of serdce or feeder fee Each branch circuit $2.00 b) l~e fee for branch circuts wi~om ~urchase of service or feeder fee First branch circuit -- $35.00 Each additional branch circuit $2.00 E. Miscellaneous (Service or Feeder Not Included) Each pump or irrigation ~ircle $40.00 Each sign or oatEn¢ fighting $40.00 Signal circuit(s) or a limited energy ] psnel, alteration or extension -~ $40.00 F. Each additional Inspection over the allowable in any of the above, per h~pectuin $35.00 G. Minor Installation Labels Pack c~ 10 labels @ $5.00 each $50.00 (sold only to electrical contractors) H. Other ( As required by Building Official) 5. FEES A 1. Enter total of fees from Sec.//4 A2. Add 5% su~harge (.05 x Al) Subtotal B. Enter 25% of line A1 for Plan Review (See. 3), if required C. Investigation Fee (ff required) D. Reinspection Fee ($25.00) TOTAL AMOUNT DUE MC 15-34 11/91 Receipt No.