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I. LOCATION OF ~N$'fALLA'rlON <br /> <br />Property Ow~: (g/ease pflnO <br />Maili~ ,e~lrcss: <br /> <br />Cie/: Smt~: Zip: <br /> <br />Owr, cT'S Signature: <br /> <br />,3, PLAN RE%flEW SECTION <br /> <br /> M&rioa County ~ no~ r~u~re a p~ ~. We.ll p~ <br /> <br /> MARION COUlnTY BUIM)ffqG IN~P£CTiON <br /> 3150 Lan~ 1~0 Lencas~' Dr, ~ - Suite C <br /> Salem, Oregon 9730~ <br />8.~0 am - 4'30 pea 24 hz. ~ Lbae 373-4427 PAX 585-7948 <br /> <br />4. IqL'E S(]I~DULE (¢omplet~ and eater Io~1 in Al) <br /> Numba' of h,.,p,~o~s per ~t <br /> <br /> Included <br /> <br />-E~ch .~.,~,:,neJ $ O0 Sq. Ft. ~ godlou dm',:~f <br /> <br />Coo (each) Sum <br />$110,oo-$ 4 <br /> S 20.00 -$ <br /> $30.00 ~$~1 <br /> <br />z $ ~2.00 = $ 2 <br /> <br />vt SeFVlC~ Or Feedcm (Does not include b~aseh C'irc ni~, ste ,Secdoa D) <br /> <br />201 amt~ta400 main x $ 60.00 * S 2 <br />40t maps m 600 amps x $t30.00 ~ <br />601amps te l 000 amps x ~170,00= $,, 2 <br />Ovcr 1000 amps ~ vel~ x S390.00 = $ 2 <br /> <br />C~ Tempo~r~ ~rv~er.&Tc~ler~ <br />lut~hlfion, ~l~radott, or Relocation <br />200ampa~r k:~ n $45~0 = S 2 <br />~1 at~m4~Oam~ x S 55.00 = S <br /> <br /> Ncw~ ~n~ or ~n ~cr Panel <br /> b)~~~ <br /> <br /> F, ~ A~o~d ~cfion, over ~e allo~Me <br /> I1 any of ~c ~e, ~r ins~Ron __ x $ 50,~= S <br /> <br />TOTAJ~ <br /> <br />5, FEES <br />Al. Enter Total Fees fr~n S~ion #4 <br />K?. Add S~ Su~hatg~ ~ ~ Al) <br /> <br />SUBTOTAL: <br /> <br />B. E~ter 30% of linc Al for Plan <br />C. lav~;~n Fee, d~u~ <br />D. Rc~ F~ (S5o_oo) <br />E, Ad~n~ P~ g~ <br /> m~im~ on~ ho~) <br />F. ln~oa for whi~ aa f~ ~ ~y <br /> <br /> $~2.50~, m~um ~0 <br /> <br />MC 15-34 Rcv 9/98 <br /> <br /> <br />