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FOR CITY VALIDATION <br />Received by: <br />D~te: [ 24 Hr In~ection Line: 5BB-'P~04 DStO: <br /> <br /> Zlili <br />Please complete all Sections, I througi~ <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />MARION COUNTY BUILDING INSPECTION <br />COMMUNITY DEVELOPMENT CENTER <br /> 285 Church St NE * Room 132 PlzRMff NO: <br /> Salem, OR 97301 <br /> <br /> below) <br /> Number of lnspeotion~ po' permit allowed <br />M^RIQN C d,~,i.I Pe¢ U. it <br /> <br />p~RMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT <br />STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />2.B. FOR OWNER INSTALLATIONS <br /> <br />NI <br /> <br />Property Owner ~o/e~ print) <br />Mailing Address I Phone <br />City/State/Zip <br /> <br />~. PLAN REVIEW SECTION <br /> <br />;Pir~Tg:~lo~ l~. ss~.oo 4 <br />F~ch additional 500 sq. fl. <br /> or portion t~exeof $15.00 <br />L~iled ~rgy $30.~ I <br />~ch Manufactu~ H~e or Modul~ <br /> <br /> B. 8~i~ or F~s (~s not ~clu~ ~ch cimui~ see section D) <br /> <br /> ln~talhtion, Alte~ati~o or Rtdoeation <br /> 200 amps or less I $50.00~'~2 <br /> 201 amps lo 400 amps $60.00 -- 2 <br /> 401 amps to 600 amps $100.00 2 <br /> 601 amps to 1000 amps $130.00 2 <br /> Over 1000 amps or volts $300.00 2 <br /> Enconn~et only $40.00 2 <br /> <br />C. Temporary 8eevi~'Pe~de~ <br /> <br /> ~00 amps or les~ $35.00 -- 2 <br /> 201 amps to 400 amps $40.00 2 <br /> 401 amps to 600 amps $~0.00 __2 <br /> Over 600 mnp~ or 1000 vol~ <br /> <br /> a) The fee fo~ branch circuits with <br /> ' , =ooZO <br /> Each branch circuit . <br /> <br />b) The fee f~' branch circuits wilhont <br /> purchase of service or feeder f~e <br />Firal branch cir~ult <br />Each additional branch circuit <br /> <br /> ~ch si~ or outline light~g <br /> Si~ cigui[(s) or a I~tt~ enegy <br /> <br />P, Each additional lnsp~ <br /> ~er the allowable <br /> above, ~r Inspectbn <br /> <br /> Pack of lO [abels ~ $5.~ each <br /> <br /> (~ required by <br /> <br />$35,00 <br />$ 2.00 <br /> <br />$40.00 -- 2 <br /> <br />$35.00 <br /> <br />$50,00 -- <br /> <br />___~q. [L x$.06 =__ <br /># of Labels NIC <br /> <br />5. FEES <br /> Al. Enter tolal of fees from Sec. g4 $..-L~__-~ <br /> A2, Add 5% suecharg~ (,05 xAI) $~.~.~,~g· <br /> Sobtotal $ <br /> <br /> B. Enter25% of lineAl for PlanRe~ew <br /> (~c. 3), if ~qui~d $.~ <br /> C. I~gsfigation ~e (ifgquigd) $ ~ <br /> D. Reimpec6oa F~ ($25.~) $. ~ <br /> <br /> Receipt No. <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 l~J4 <br /> <br /> <br />