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IFOR CITY VALIDATION <br /> Received by: <br /> Date: <br /> <br />MARION COUHTY BUILDING INSPI CTION <br /> COMMUNITY DEVELOPMENT CENTE <br /> 285 Church St NE' R~m 132 <br /> Sal~. OR 9730 <br /> <br /> D~ <br /> ~ Hr In~ L~ 58~7~ ~lO~ GOHNTY <br /> <br /> Office: 588-514'/ 8:00a.m. - 4:30p.m. <br /> <br />Please <br /> Nmnbor of Inepectlona pet permit allowed <br /> Reeidential <br /> pe~ <br /> Unit <br />1. LOCATION OF INSTALLATION [ter~ Coat (each) Sm <br /> <br /> ~TS A~ NON-~S~B~ AND ~P~ IF WO~ IS N~ I <br /> STARED ~ [~ DAYS OF ~SUAN~ OR ~ <br /> WO~ IS SUSPEND~ FOR I~ DAYS, <br /> <br />~. CO~CTOR ~LATION O~Y <br /> <br />Mailing Address <br /> <br />Property Owner <br /> <br />~n~actor'a Lic~e <br /> <br />Phone <br /> <br />Contraclor'a Board Reg. No. CXa 3 ~ ] Job No. <br />Signatm of Supervising Ele~rician <br /> <br />Supervisor's License No. ~"[ {3 .~ <br /> <br />2B. FOR OW~ INSTALLATIONS <br /> <br />Property Owner ~laaso print) <br /> <br />Mailing Address I Phone <br />City/~a~fZip <br />Owner's Signature: <br /> <br />3. PLAN REVIEW SECTION <br /> <br />Marion County does 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 15-34 12Y94 <br /> <br />~-viee Included: <br />1000 aq. 11. or le~ $85.00 4 <br />F. aCh a&titional 500 aq, ft. <br /> or portion thereof $15.00 <br />Limited Energy $20.00 1 <br />Each Manufactur~l Hmne or Modular <br /> I~vdling Service or Feeder $40.00 2 <br /> <br />B. Serviced or F~d*r s ~ not include br~nch cimuil~, s** section D) <br /> <br /> Installation, Alt~atio~ o¢ R~e, atiofl <br /> 200~Unl~orle~ ~ $~.~ ~ 2 <br /> 201 ~ to ~ ~ ~.~ 2 <br /> ~l am~to~ $1~.~ ~2 <br /> ~1 am~ to l~ ~ps $1~.~ 2 <br /> ~r 1~ raps or vol~ ~.~ 2 <br /> Re~ot o~y ~ ~.~ 2 <br /> <br />C. Te~ary ~s <br /> /n~alktin~ ~ati~, ~ R~tlon <br /> <br /> 20l ~ to~ ~ ~.~ 2 <br /> ~1 ~ to ~ ~ $~.00 2 <br /> <br />D. Bran~ C~caita <br /> <br /> a) ~e fee f~ b~ch c~ui~ ~ <br /> p~haae of ~i~e of feeder fee <br /> ~ch b~ c~uit $ 2.~ <br /> <br />$35,00 <br />$2.00 <br /> <br />E. Miscellaneous (Secvice~ Enede~ Not Included) <br />Each pump or irrigation circle $40.00 2 <br />Each sign or outline lighting $40,00 2 <br />Signal circuit(s) or a llmi~d <br />psnel, alte~tina or extev.*ion $40.00 2 <br />F. llach odditio~ml inq~-tion <br />Over the allowable in any of the <br />above, per Impeetlon $35.00 <br />O. Min~ In~tall~tion Lab~la <br />Pack of 10 label~ @ $5.00 ach $50.00 <br />(~old only to electrical contractor*) <br />H. Olh~ <br />(A~ required by B~ilding Og~cinl) <br />At~ora Dwelling Eleeldeal Fee <br />Dwelling Permit Label # of Labels N/C <br /> <br />5. FEES <br /> Al. Enter ~,tal of fe~a from S~c. #4 <br /> A2. Add 5% surchat~ 605 x Al) <br /> <br />Subtotal <br /> <br /> Enter 25% of line Al for Plan Review <br /> (See. 3), if r~quired $__ <br /> Inv~tigntinn Fee (if r~quin~d) $__ <br /> Reinspeetion Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUB $/O~ <br />Receipt No. <br /> <br /> <br />