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MARION COUNTY BUILDING INSPECTION <br /> 220 High Street NE <br /> Sa~m, Omgon 973Ol <br /> Phone 588-,5147 8:00 a.m, - 4:30 p.m. <br /> <br /> lAX: ,58~ 7948 <br /> <br />ELEC~ ~ICAL i=F.R~ffff APPtJCA330N <br />Please ~orr~ete all S~ctions, 16~3u~h 5 <br /> <br />SITE t~: Permit No, <br /> <br />Issued <br /> <br />2iL FOR OWNER I~E~TALLA'IIONS <br />Property OWrmr <br /> <br />The InstaUetion is being made on property I own which is not intended for sale, <br /> <br />Owner's $ gnaturs, <br /> <br />Ch~c.k apprOpna~ imm a~d enter fee in Sec~n SB. <br /> <br />~ Connectsd Load over 200 amps (except single family dwellings) <br />_,, Building system oVer 200 amps (except single family dwellings) <br />~ System o,.,er 600 v~te <br />__ Building over 2 s~rles <br />__ B~ilding over 100000 ~luam feet <br /> Occupant k)ad over 300 persons <br /> _ Manufactured Dwel/Jng Paff./Recmatlen Pa~ <br /> Hazardous Locals <br /> <br />Submit 2 sets of plans with any of the above, <br />Temporary construc~on setvices, fie not apply, <br /> <br />4, FEE SCHEDULE (Complete and enter total in A1 below) <br />Humber of Inaps~.t~ons per permit etlo~ed <br /> <br />A. ResldentlaI, Slngleor Item~ X Cost = Total <br />MuR[.Fam#y pe~ dwelling unit <br /> <br /> ~h~"l~O~,,~.~po~n ~ $ 15. ~ <br /> E~h Mfg'd H~ m M~I~ <br /> <br /> 10~ ~ste~ ~ ~ <br /> <br />~l~or~ ~ ~,~ <br />c. Tem~m~ ~e~F~ <br /> <br />Al,, Eofer total of fees from See./M <br />A2, AddS% sarcharge (,05xAO <br /> <br /> SubtotaJ <br /> <br />B. Entel 25% of llma A~ fro' P~an Re'.'~ew <br /> (Se~. 3), if required <br />C, Invesligali¢~ Fee (if required) <br /> <br />TOTAL AMOUNT DUE <br /> <br /> <br />