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FOR. OFFI~CE~E ONLY I MARION COUNTY BUILDING INSPECTION <br />Received by:~ 220 High Slreet NE <br />vate../.d _gfl.~ 7 , [ Salem, Oregon 97301 <br /> Phcae 588-5147 8:00 am: 4;30pm <br /> Cede-A-l~none: ~8-7904 SITE #: <br /> <br /> ----'~C! 3 I 1337 -- Issuedby: <br /> <br />Permit No. <br /> <br />1. LOCATION OFINSTALLATION MARION COUP, <br />~obAed,~. ~ 1333 A;~,~/ZTY ~T~T-BUILDING IN~;PEt <br /> <br />PBRMIT~ ARE NON-TRANSFERABLE AND NON-REFUNDABLE AND s <br />EXPIRE IF WORK IS NOT STARTED WITHIN IS0 DAYS OF ISSUANCE <br />OR IF WORK IS SUSPENDED FOR 180 DAYS, <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />2B. FOR OWNER INSTALLATIONS <br />Property Owner <br />Mailing Address Phone <br />City/State/Zip <br /> <br />The installation is being made on property I own which is n~ intended for sale, <br /> <br />Owners Signature <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 Cede, Chapter 53. <br /> <br />MC15-$4 11/91 <br /> <br />TV. FEE SCHEDULE (Complete and eater total hi A1 below) <br />',TION Numbe~ of Inspections p~r pomJt allowed-=] <br /> <br /> A. Residential Per Unit <br /> Service Included: Items Co~t (each) <br /> <br /> 1000 scI. fl. or less $85.00 4 <br /> Each additional 500 sq. fl. <br /> or 'on themof $15.00 <br /> ' s o.o0 <br /> Ench Manufd Hmne or Modular <br /> DwelEn$ $eO, ice ~ Eneder $40.00 2 <br /> <br /> a. Ser-,4~es or~s not inlcede branch circuits, see section D) <br /> Instalhdon, Alterations or Relocation <br /> <br /> 401 amp~ to 600 amt~ $100.00 2 <br /> 601 ~mi~ to 1000 aml~ $1~0.00 2 <br /> O~r 1000 ~-nl~ orvo~ $800.00 2 <br /> Reconnect cely $40.00 2 <br /> <br />C. Temporary ServlcedFt~let~ <br /> Instnllnflon, Alteration, or Rdocation <br /> 2~ ~ or less <br /> <br />E. Ml~n~s (~r~ or F~er N~ Inclnded) <br /> ~ ~p ~ ~ ~e _ <br /> <br /> Sign~ ~t(s) ~ a ~t~ enemy <br /> <br /> ~er~e ~able ~ ~y of~e <br /> <br /> (~d o~ to electr&al comracturs) <br /> <br />H. ~her <br /> <br />$135.00 2 <br />$40.00 2 <br />$80.00 2 <br /> <br />$2.00 <br /> <br />$35.00 <br /> $2.00 <br /> <br /> 40.00 2~' <br /> 40.00 <br /> <br />$40.00 -- 2 <br /> <br />$~5.00 <br /> <br />5. FEES <br /> Al. Enter tctal of fees from Sec. #4 <br /> A2. Add 5% surcharge (.05 x Al) <br /> <br /> Sub*oral <br /> <br /> B. Emir 25% of I/ne A1 for Plan Review <br /> (Sec, 3), if r~quired <br /> C. Investigation Fee (if required) <br /> D. Rdnspex:dcn Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br /> <br />$ ~"T, r~ <br />$-~ <br /> <br />$&O, 9~ <br /> <br /> <br />