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' ~. ............ MARION COIJNTY. BUILDING INSPECTION <br />FOR OFFICE USE ONLY COM~m4~W DEVI~LOPMBNT CENTER <br />Received by' [ ~SSCh~hSt NE - ~oom 132 /~/~ <br /> <br />Direcdms <br /> <br />PERS{FfS ARE NON-'tI~.ANSFEKABLE A. NT~ NON.REFHNDABL~ ANI) <br />EXPIRB IF WORK I$ NOT STARTBD W1Ti,I~q' 180 DAYS OF ISSUANCB <br />OR tF WORK IS SUSPBNDBD FOR 180 DAYS. <br /> <br />2A, CONTRACTOR INSTALLATION ONLY <br /> <br />Elec~ricalCo~tractor ~3I;~.i~ ~ ~ <br /> <br />Rug, so..4 I I oh <br /> <br />City/$~a~efZip <br /> <br />The inst~Iation is b~lg mado on pro~i~y I own which is nq~.cintended for sale. <br /> <br />3, I'LAN REVIEW SECTION <br /> <br /> We will provide plan review service if you complete Section <br /> 5II and submit two (2) sets of plans and specificatioRs with <br /> this application. <br /> <br />This optlonal plan review progq'am does not suspend the <br />reqaircd submission of lighting power calculations, plans, <br />and specifications wllcn required by the Oregon Structural <br />Specialty Ctxte, Chapter 53. <br /> <br />4l FEESCHEDULE (Complete md en er o al m A1 belo ) <br /> <br />A. <br /> R~identlal <br /> Unit <br /> Service Included: Items Cost (each) Sum <br /> <br /> 10~ sq, ft. m lesx $8S,00 ~ 4 <br /> Bach ad~fi~l <br /> or ~m the~of $15,00 <br /> <br /> Dw~ng S~ or Feeder $40,00 ~ 2 <br /> In~llatlon, Alterations or Rd~atlon <br /> <br /> 401 ~mpa to 61~ amps <br /> 601 amtl~to 1000 amps <br /> <br />C, T~rapor ary <br /> Ins~lla~on, Alt~atlon, or Rd~ation <br /> 2~ ~ps or less <br /> 201 ~p$ <br /> 401 ~p* to ~ amps <br /> ~¢[~ ~pa or 10~ volts <br /> <br />D. Branch CIm~i~ <br /> New, Al~aflon, or ~slon Per Panel <br /> <br /> ~&ch~e d semi¢ ~ fecer fee <br /> <br /> b) ~e <br /> <br />El Mi~ceHen~us (Service or Feeder Not Included) <br /> ~ ~p or iffi[a~ circle <br /> ~ach s~ or ~e ~gh~g <br /> S~nal clrcult(~) <br /> <br />F. Each additional Insp~tlon <br /> over <br /> a~ve, <br /> <br /> ( As ~qMred <br /> <br /> 50.00 <br /> ~60,00 ~2 <br /> 2 <br />$1oo,oo 2 <br />$130.00 2 <br />$$00,00 --2 <br />$40,00 __ 2 <br /> <br />$35,00 ...... 2 <br />$40.00 __ 2 <br />$30.00 ..... 2 <br /> <br />$2,00 <br /> <br />$35.00 <br /> <br />$40.00 Il 2 <br />$40.00 ~ <br /> <br />$40.00 __2 <br /> <br />$85.00 <br /> <br />$50.00 <br /> <br />5. FEES <br /> A I. Enter total of fee~ from Sec. #4 <br /> <br /> Subtotal <br /> <br /> B. Enter 25% o[l~neA1 for Plan Review <br /> (See. 3), it' rerglirod <br /> C. h~vestigationFee (ff mqulrcd) <br /> D, Relnspecfion Fee ($25,00) <br /> <br /> TOTAL AMOUNT DUE <br /> <br /> Receipt No. <br /> <br />$ <br />$ <br /> <br /> <br />