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MARION COUNTY BUILDING INSPECTION <br /> 220 High Street NE <br /> ~., Sa~m, Oregon 9730~ <br /> Phone 588,.5147 8.00 a,,m. - 4:30 p.m,, <br /> SITE #: <br /> <br /> lesued by: <br /> <br />Malting Address <br />Property Owner %>>., rD~ jd..~/c2 <br />Contra,tot's Board Reg,, No,, l/~ 1~'~ <br /> <br />Superv[sot's Li~nae No. ~ Phone No,, <br /> <br />2B. FOR OWNER ~ISTALLA'flGNS <br /> <br />Property Owner <br /> <br />Mailing Address I Phone <br /> <br />City/State/Zip <br /> <br />The installation is being made on property I own which Is not intended for sale, <br />lease or rent,, <br /> <br />Owner's Signature <br /> <br />Permit No. <br /> <br />4, FEE SCHEDULE (Complete and enter total tn At below) <br />Number of InspeofJons per permit allowed <br /> <br />A. Residential, Slngleor Item~ x C,o~t = T~I <br /> <br />Multl-Femlly per dwelling unlt <br /> <br /> ~h Mfg/d H~ or Modulm <br /> ~li~ ~ or f~r <br /> <br />(10 Br~ ~ ~) <br /> <br /> ~1 a~te 10~ <br /> <br /> R~nn~ Only <br /> <br />~ Tem~m~ <br /> <br /> ~er ~ ~s et I0~ volts (~ <br /> <br />D, Branch Clmul~ <br /> <br />(~ ~ F~ not <br /> E~h pu~ ~ i~aflon Wcle <br /> ~h s~n or outline I~hang <br /> Sign~ clmul~s) or a li~t~ e~y <br /> <br />F. ~h edd'l les~eaen <br /> <br />G. Mther lna~lle~on ~ia <br /> P~k of 10 I~els ~ $5.~ ea~ <br /> <br />3. PLAN REVIEW BEC]K3N <br /> Check app/opriate item and enter fee in Section SB. <br /> <br />__ Connected Load over 200 amps (except single family dwellings) <br />__ Building system over 200 amps (except single family dwellings) <br /> System over 600 volts <br /> Building over 2 stories <br /> B~ilding over 10,000 ~uam feet <br />__ Occupant load over 300 persons <br />__ Manufactured Dwelling Pmk/Recma~n Park <br /> Hazardous Lesa~ns <br /> <br />Submit 2 se~s of plans with any of the above,, <br />Temporary conslruGrion services do not apply. <br /> <br />At. Enter tore] of fees from see. ~1, <br />A~. AddS%surcharge (.05xAt) <br /> <br /> Subtotal <br /> <br />B,, Enter 25% of line At for Plan Review <br /> (Sec, 3). if required <br />C. Investigation Fee (if required) <br />D. Relnspe~on Fee ($25,00) <br /> <br /> TOTAL AMOUNT DUE <br /> <br />$ <br />$ <br />$ <br /> <br />$ <br /> <br /> <br />