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FOR OFFICE USE ONLY <br />Received by: <br /> <br />MARION COUNTY BUILDING iNSPECTION <br /> <br /> 'Salem, Oregon 97301 <br /> <br />Date: <br /> <br />Phone 588-5147 8:00 am - 4:30pm <br />Code-A-Phone: 558-7904 <br /> <br />SITE#: ~ ~' 0 I'~ermitNo. <br /> <br /> FAX: 58g-7~8 <br /> LECmlOAL P RM TAPPUC^T ON I l <br />Please complete all Sections, I through 5 I_ ~1 ~ ~/~/ <br /> <br /> i. LOCATION OF INSTALLATtONJ~' ~ ¢. *-~firfi~- 4, FEE SCI-IEDULE (Complete and enter total m A 1 below) <br /> <br />ER~iPERMIq~ ARE NON-'iTtANSFERABLE AND NON-REI4JNDABLE A2~D <br /> 1RE IE WORK iS NOT STARTED WITHIN 1 $0 DAYS OF ISSUANCE <br /> F WORK IS SUSPRNDED EOR ! $0 DAYS, <br /> <br />Supervisors License N0; <br /> <br />2B, FOR OWNER INSTALLATIONS <br /> <br />Property Owner <br /> <br />Mail{ng Addres~ <br /> <br />City/State/Zip <br /> <br />Ii'hone <br /> <br />INSTALLATION ONLy <br /> <br />The installation is berg ma& on pvol~rty I own which is not imended for sale. <br /> <br />3. PLAN REVIEW SECTION <br /> <br />We will provide plan review service if you complete Section <br />5B and submit two (2) sets of plans and specifications with <br />this application, <br /> <br />This optional 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 />Specialty Code, Chapter 53. <br /> <br />Date: MARION COUNTY <br />Issued ~.ILDIN6 INSPECTIOb[ <br /> <br /> Number eft Inspections per permit allowed <br /> <br />A. <br /> Residential <br /> Per <br /> Unit <br /> Service Included: Items COST (each) Sum <br /> <br /> 1000 sq, fi, or less $S5.00 __ <br /> Each add~onal 5~ sq. <br /> or ~ffi~ ~e~of $15,00 <br /> ~d E~y $20.00 <br /> B~ M~ufd Home or M~ular <br /> Dw~ Se~ ~ Feed~ $40.00 ~ <br /> <br /> Ins~llatlon, Alterations or Rel~at[on <br /> ~ amps or lc~ ~50,00 ~ <br /> ~1 ~pa m 4~) amps $60.00 <br /> <br /> ~1 am~to 1~0 amps $130,00 <br /> $300,00 ....... <br /> R~ect rely SdO.O0 <br /> <br />C. Temporary <br /> <br /> 2~ ~ps or less $35.00 ~ <br /> 201 ~ps to ~0 am~ $40,00 . <br /> 401 ~p~s to ~0 amps $80,00 <br /> <br />D- Branch Clrcuim <br /> New, AReradon, or Extension Per Panel <br /> <br /> a)~e f~ f~ bran~ drca[ts with <br /> pnrchase of se~m ~fcedgr <br /> <br /> Each brmch c~uit ~ $2.00 <br /> b) ~e f~ fm ~nch Mrcuts ~ <br /> <br /> ~ ~di6~ brach elteuit $2.00 <br /> <br />E. Mlscellan~us (Service or Fe~er Not lnc~udod) <br />~ach pump ~ ~gafi~ ~rele Sg0.00 <br />Each sign Or ouflioe l~ht~g $40.00 <br />Signal circuit(s) or a ~md ~e~y <br />panel, almrati~ or extcmsion ..... $40.00 ~ <br /> <br />F. ~ch addiaonal Insp~tlon <br /> <br /> a~, per hs~on $35.00 <br /> <br />O. Minor lns~llation Labels <br />Pack ~ 10 la~ls ~ $5.00 ea~ $$0.00 <br />(sold oMy to electrical contractors) <br /> <br />~. Other <br /> ( As req~red by Building Officio <br /> <br />5. FEES <br /> A 1, En~r lotal of fees from $¢e, #4 <br /> A2, Add 5% surcharge (.05 x Al) <br /> <br /> St~btotal <br /> <br /> B. Enter 25% of line A1 for Plan Review <br /> (Sec. 3). if required <br /> C. InvestigationFee (ff mquirod) <br /> D, Rein~p~fion Fee (825.00) <br /> <br />MC ,15-34 11/91 Receipt No, <br /> <br /> <br />