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U C .STAU_A C MARION CC <br /> <br />city ' C~as St. ' <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> 22o High SUeet NE <br /> SaJen~ Om(jan 97301 <br /> <br /> PJzq~e 588~5147 8.'00 a,,m. - 4:30 p,m, <br /> ITE ~ Parma! <br /> <br /> Number of Inapeodons per permit slimed <br /> <br />EJe Ic~a antra ~ ' ~ ......... <br /> <br />cOntra~r~s~oa~d Reg No,, ~ ~ ~ J~ No, <br /> ,,, ~/~x/,/'1 ~, ~ <br />Signature .... of Supervising Elec~ioian ~ ~ ~ <br />Supervlaor"e Lloense NO, ~q~_~ ~ Phone No, ~-0~ <br /> <br />2B, FOR OWNER ICSTALLA3X3NS <br />Property Owner <br /> <br />Phone <br /> <br />The Ins[allatlon is being made on property I own which is not intended for sale. <br />lease or rent, <br /> <br />3. PLAN REVIEW SECllON <br /> Check appropt~te item and enter fee in ~;tion <br /> <br />__ Connected Load over 200 amps (except single family dwellings) <br /> Building system over 200 amps (except shgld ~mily dwellings) <br />. System over 600 volts <br />~_ Building OVer2 stories <br />__ Euilding over 10.000 square feet <br />.. Occupant load over 3~0 persons <br />__ Manufa~ured Dwel~ng Park/Flecma~n Pa,'k <br />___ Hazardous Loosens <br /> <br />Submit 2 sets of plans with any of the above. <br />Temporary consl~uction services do nut apply, <br /> <br />bale, w) <br /> <br /> MulE-Family per dwelling unit <br /> ( $~,i;e induded) <br /> 1.500sq,,It, orless __ $ 85 <br /> Eac, haddalS00sq [t.O*'portien ,, $ 15 <br /> Each Mfg,'d Honm or Modular <br /> Dwelling sen~k;e or feeder $ 35,, <br /> <br /> ( t o 8ran~ C4rc~t~/nalod~'] <br /> <br /> Reconsect Only <br /> <br /> C. Temperary ,t~ervlvo~/Feodem <br /> <br /> :L~01 ampoto4OOamps __ $ 40. <br /> 401 ampe to 60O er~ca __$80-- <br /> Over co0 amps or 1000 volts (See <br /> <br /> One circuit __ <br /> <br /> Eaohpumporirdgatlen~yale __ $ 36. <br /> Eachsign otoutliselighling __ $ 36. <br /> Signal alrcuit(s) Or a Ilrilitod energy <br /> <br /> the abovea pe~ In~pection __ $ 35. <br /> <br /> Packoll0labels@$5.00ea~h __ $ 50. <br /> (sold grimy to electrical coc, bacte,.'s) <br /> <br />H. Other <br /> (As requir~ by Bui~g <br /> <br />A1 ,, Enter total ot fees from Sec,, #4 <br />A2,, Add5% surcharge (.05xA1) <br /> <br /> Subtotal <br /> <br />B. Enter 25% of line At for Plan R~vlew <br /> (Sec,, 3). if required <br />C. Inves~gatiee Fee (if required) <br />D, Reinspec~on Fee ($25,00] <br /> <br /> TOTAL AMOUNT DUE <br /> Recelpt No. <br /> <br /> <br />