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II:¢)lt IHCH(:E USE ONIN <br /> Rct'~,ivcll b.¥: .......... <br /> I)ale: <br /> <br /> Phone 588-5147 8:~O ~an - 4:3Opm <br /> Code-A-Phone: 558-7~14 <br /> FAX: 588.7948 <br /> <br />EI.ECTRICAI. PFRMIT APPLICATION <br />Please complete afl Sections, 1 through 5 <br /> <br />MARION COiJNT¥ Bi,tliA)ING INSPECTION <br /> <br /> Salem, Oregon 97301 <br /> <br />9493 POTTER ROAD <br /> ....... 1':,,,- <br /> <br /> S()UTtt OF AUMSVILLE <br /> <br />.... .... <br /> AMP <br /> (2) <br /> ?tOO AMP FEEDERS <br /> <br />PbRMI'IS ARE NON-'IRANSI"ERAIII,E AND NON ,REI:UNDABI,E AND <br />hXPIRE W W(IRK IS NOT STARTIil) WllUlN I§O DAYS OF ISSUANCE <br />OR IF WORK IS SIJSPENI)EI) FOI( I~0 I)AY~, <br /> <br />211, Foil OWNER INb"I'AI,I,ATIIIN~ <br /> <br />SITE #: <br /> <br />Dale: fCl/~l~!ON COUN]'¥ <br /> BUILD NG INSPECTI <br />Issued by ,_ON <br /> <br />Wc will provide plan review SCl'vice il' yol,~ complete Section <br />5B ami Sl*tmfiI two (2) sols of plans and specificadons wilh <br />ihis applicaIion. <br /> <br />This oplil)llal pkm review pn)gralll does ilot Suspend the <br /> <br />Spcciahy fkxl¢, Chapter 53, <br /> <br />M(' 15 31 11191 <br /> <br />l:imi"P°~i'm'~4E m~m°[ $15 O0 <br /> In$1ltlallon, All.aliens or Relocation__,_3 $ ~ 5 0 . 020 <br /> <br /> Over 6~O an,pa or l~lO voh~ <br /> <br /> l-!f~:h~e ~f ~en,ice or (coder ~ <br /> Each br~lgh circuit 2 0 <br /> <br />b) Thc f~ for branch cb'cms A~ <br /> mlrchase of ~e~icq ~r [~e er ~ <br /> <br /> Each signor ~tline lighdng <br /> <br />$35 O0 ____ ~ <br />$4ooo ...... 2 <br />$80 O0 ___ 2 <br /> <br />40.00 <br /> <br />$35 O0 <br /> $200 .... <br /> <br />$4000 <br />$4o OD <br /> <br />$40 O0 -- 2 <br /> <br />$35 OO <br /> <br />$so6o ..... <br /> <br /> FEES <br />A 1, Enter latal of fees from $¢c, #4 <br />A2, Add 5% surcharge (.05 a Al) <br /> <br /> Subtotal <br /> <br />[1, Enter 25% of line Al for Plan Review <br /> (S~. 3), if ~quit~ <br />C. InvcaligatlonFee (if requited) <br />D. Reins~ctk~ Fee <br /> <br /> 3OTAL AMOUnt I)UE <br /> <br />$190. On <br /> <br />$!99.50 <br /> <br />Il Ret°Jla No, <br /> <br /> <br />