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Ree.~ived by: .... <br /> <br /> RUILOIt4G 1~8PE~N <br />IELE~RICAL PERM~ APPLICATION <br />Ple~e complete <br /> <br />BUILDING INSPECTION <br /> EVEL:O!MENT cENTeR <br /> $! NE Room 132 nr,',,,,',' ~,~. <br /> _ _ ; ..I M..-~ ~'ahml, OR 973 <br /> <br />~R~0N Cuu~ce: Phone S~-S)47 a:0~m - 4:3~m <br /> ~AX: sa~-7~48 Issu~ by: <br /> <br />PERIVlIT$ Al~ NON.TRAIq$F'ERABI~ AND EXPIRE iF WORK IS .NOT <br />STAR'm~ WTrmN ! 80 DAYS OF ISSUA~iCE OR IP <br /> WORK 1~ SUSFRNDED FOP. 180 DA ¥$. <br /> <br /> CONTRACTOR INSTALLATION ON]LY <br /> <br />Propc~.y Owner (plmm pHnO <br /> Addr~s [ Phone <br />City/$ta~tZip <br /> <br />3, pLAN RliVlEW SECTION <br /> <br /> Marion County doe~ not require a plan review. <br /> We will provide plan review service if you complete <br /> Section 5B and submit two (2) sets of plans and <br /> specifications with this application. <br /> <br />MC 15-.~4 1/96 <br /> <br /> Nm~of ~ap~t~o$ <br /> <br />D~lling S~ioa or Fo~d~r ~ $~ 2 <br /> <br /> 201 ~ lo 400 <br /> 401 an~s to {vi) <br /> 601 aml~s to 1000 ~mps <br /> Over 1000 amps or volts <br /> R~:onrggt only <br /> <br /> Inl~allatiou. Alt~'atk~, ~ R~ti~ <br /> <br /> h) ~ fee f~ ~l~ll ei~uita wi~ut <br /> <br />additbnd bnmeh <br /> <br /> ~ch pump ot ~jgalbn <br /> <br /> 8iglla{ C~I(m) ~ n hmi~ cn~ <br /> <br /> Raeh nddRional <br /> <br /> H. O~ <br /> <br /> .... $60.00 <br />~ $100.00 <br /> $130.00 <br /> Sa00,00 <br /> $40.00 <br /> <br />$35.00 2 <br />sno.oo 2 <br />S~0.00 ,, 2 <br /> <br />$35.0O <br />$ 2.00 <br /> <br />$4O.00 2 <br /> <br />$35.00 <br /> <br />$$0.00 <br /> <br />(A~ required by Building OfilelaO <br />Aurora Dwelling Igl~euical F~ .vq. fl. ~ $.068 - <br /> <br />5. FEES <br /> A I. Enter tolal of logs from SEc. #4 <br /> A2. Add 5% surcharge (.05 x Al) <br /> <br />Subtotal <br /> <br />B. Enter 25% 0£ line A I for Pled{ R~icw <br />(Sec, 3). if ruquired $ <br />C. ]nyg~ IgahOll Fas (I f <br />D. ~p~;tion Fee ($25.~) $ <br /> TO'i'~ ~O~ D~ $~ <br />R~c~ipt <br /> <br />I00~ dl;NI O~l~ NOI}IV~ gt'6; ~9~i g0~' I XVd 8I:gI 3il& 1.6/80/t0 <br /> <br /> <br />