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[FO~ USE ONLY <br /> OFF/CE <br />J Received?y: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br /> · 220 H~h Street <br /> <br />Plume 588-$I47 8:,.0~, ~n- <br /> F~ 588-7~8 <br /> <br />Please complete all Sections, 1 through 5 <br /> <br /> I. LO~ATION OFINSTALLATION <br /> <br /> City Cross $~ <br /> <br />SEP 7 <br /> <br />Date <br /> <br />ISSU <br /> <br />Dir,~-ac~s <br /> <br /> pEPO/RTS ARE NON-TRANSFERABLE ~ NON-P~FU~DABLE AND <br /> EXPIRE ]~ WORK I$ NOT STARTED W'~{TI]N 180 DAYS OF ISSUANCE <br />I IF WORK I~ SUSPENDED FOR 180 DAYS. ,, ,, <br /> <br />3A. CONTRACTOR INSTALLATION ONLY <br /> <br />Contractor's Li~,e~ s~ No, <br /> <br />Prot~y Owner <br /> <br />City/S;atef~ip <br /> <br />Owners Signature ..... <br /> <br />3. PLAN REVIEW SECTION <br /> <br />'MC 15~$4 H/91 <br /> <br />We will provide plan review service if you complete Section <br />5B and submit two (2) sets of plans and spec~ca~ons with <br />this application. <br /> <br />This optigna~ plan review program does not suspend the <br />required submission of lighting power calculations, plans, <br />and specifications when required by the Oregon Structural <br />Speciahy (Code, Chapter 53. <br /> <br /> er UnR <br />Service Included: <br /> <br />1000 sq. ft~ or l~ss <br />~ach addiaonal $00 sq. f~ <br /> or po~on thereof <br />L.i~tea Energy <br />Each Manufd Home or Modular <br /> I)v~Jllng Service c~ Fe~cler <br /> <br />pm' permit allowed --] <br /> 1 <br />Co~t (each) Stanl <br /> <br /> $8s,00 4 <br /> $15,00 <br /> <br /> $40,00 2 <br /> <br />Services or Feeders (Does not tnleude branch 6mu~t~, see section D) <br /> <br /> Installatlon~ Alterations or RelOcation <br /> 200 am~s or less <br /> 201 ~ps to 400 amps <br /> 401 amps to 600 amps <br /> 601 amps to 1000 ~mps <br /> ~ Ove. t 100O ~¢nps or votts <br /> Reconae~ only <br /> <br />C, Tempor~r~ <br /> installation, Alteration, or RelOCation <br /> 200 amps or less <br /> 201 ~nps to 400 amps <br /> 401 maps to 600 amps <br /> Over 600 amps or 1000 voR~ <br /> <br />D. Branelt Circoits <br /> New, AReration, or Extension Per P~nel <br /> <br /> a) The £~ for branch 6rcalts with <br /> <br /> E~ch branch ~r~uJt <br /> <br /> b) The fee for branch clrcuts <br /> [mrchase of se~c~ or feeder fee <br /> <br /> Firet branch elrcuit <br /> lhch afldifionat b~nch ei~u~t <br /> <br />E. Miscellaneous (Service or Feeder Not Included) <br /> Each p~mp <br /> ~aeh sign or out~ae lighting __ <br /> ~ignal eircult(~) or a ]~nlma eries3, <br /> ps,el, aiteeaaon or extension <br /> <br />F. Each aflaitional Inspection <br /> over t~e allowable in any of the <br /> <br />G, MIno~ Installation Labels <br /> Pack c~ l0 labeh @ $5.00 each <br /> (sold only lo nlectrical contractors) <br /> <br /> ( A~ required by Building Official) <br /> <br /> Al. ~nter total of fees f~om See. #4 <br /> 3.2. A~d 5% surcharge (.05 x Al) <br /> <br /> Subtotal <br /> <br /> B- Enter 25% of llae Al for Pla~ Review <br /> (See. 3),if mqu~ed <br /> C, ~nvesti~ati~n g'ee (if mqui~d) <br /> D, R¢~n~t~.:eti~ Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUB <br /> <br />Receipt No. <br /> <br /> ~50,00 <br /> ~.00 <br />$100.00 <br />$130,0O <br />$3OO.0O <br />$40,00 <br /> <br />$35.00 <br />$4o.oo <br />$80.00 <br /> <br />$ ,oo <br /> <br />$40.00 <br />$40.00 <br /> <br />$40.00 <br /> <br />$~.00 <br /> <br /> <br />