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i MARION COUNTY BUILDING INSPECTION <br />FOR OFFICE USE ONLY 22O High $=eet <br />Received by: Salem, Oregon 97301 <br />Date: <br /> Phone 588-5147 8.'00 am - 4:361~n <br /> <br /> FAX' 585~7945 '~ r' ~ ~~° · <br /> <br />1, LOCATION OF INSTALLATION <br />~obAdd~ss20237 Grim Road NE. ~ ~h, <br /> <br />c/~ Aurora c~,st Boones Ferry Road <br /> <br />Dh~c~cos West end of elementary school <br /> <br />o~on Mobile classrpom <br /> <br />PEIOA1TS ARE NON-TRANSFERABLE AND NON-REFUNDABLE AND <br />EXPIRE IF WORK IS NOT STARTED wrITHN 180 DAYS OF ISSUANCE <br />OR IF WORK IS SUSPENDED FOR ! 80 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br />ElectricuiComraetor Dryden Electric In~ ?coe 981-3913 <br /> <br />M~m~g^da~P0 Box 266, Hubbard OR 97032 <br />h'°pa~°W~orth l~.rion School I)±~°~ 678-5835 <br /> <br />¢ont~etoes Boa~a l~g. No. 98943 I Job No. <br /> <br />2B. FOR OWNER INSTALLATIONS <br />Pmpany Ow~r <br /> <br />Mailing Address Phone <br /> <br />. The installation i~ being made oo pm~ I own wh/ch is not intended for sale, <br /> lease, or ~ <br /> <br />Owner's Si/nature <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 docs not suspend the <br />required submission of lighting power calculations, plans, <br />and specifications when required by the Oregon Stroctural <br />Specialty Code, Chapter 53. <br /> <br />MC 15-34 11/91 <br /> <br />Permit No. <br /> <br />~&~EE SCHEDULE (Complete and emer total in A1 buiow) <br /> <br />':,"~' ,~'~ ~: Number of Inspections per permit allowed <br /> / <br />A. Resldeatlal Per Unit <br /> gel'vice Includ~l: Items Cost (each) Sum/ <br /> 1000 sq. i~. or ~ss $85.00 4 <br /> Each additional 500 sq. ft. <br /> or portico thereof $15.00 <br /> Limited Energy $20.00 -- 1 <br /> Each Manufd Home or Modular <br /> Dwellin~ Service or Feeder $40.00 2 <br /> <br /> B. Servtc~ or Feeders (Does not inlc~de branch circuits, see seedco D) <br /> <br /> Installation, Al~'ations or Relocation <br /> 200 amp~ or less % $50.00 50 · 002 <br /> 201 aml~ to 400 amps $~0.00 2 <br /> 401 s. rnpz to 600 amps $100.00 2 <br /> ~01 amps to 1000 ampa $130.00 2 <br /> Owr 1000 ~npa or volts $300.00 2 <br /> P.~onneet ~mly $40.00 2 <br /> <br />C. Temporary Services/Feeders <br /> <br /> 200 amps or less $35.00 2 <br /> :101 ~pa to 400 ~unp~ $40.00 2 <br /> 401 amps to 600 ami~ $80~00 ~ <br /> Over 600 amps or 10~0 volts <br /> <br />D. Branch Cireni~s <br /> New, Alteration, or Ext e~slon Per Panel <br /> <br /> a) The fee fo~ brach c/muits w~th <br /> pwcha~e of sendce or feeder fee <br /> <br /> Each brmch circuit SZ00 <br /> <br /> b) The fee for branch clrans w/thom <br /> nurchase of sendce or feeder fee <br /> <br /> First branch circuit $35.00 <br /> E~h additional branch cL-euit $2.00 <br /> <br />E. Miseeihneeus (Service or Feeder Not Included) <br />Each pump or inigatico circle $40.00 -- 2 <br />Each sign or c~tline lighting $40.00 __ 2 <br /> <br /> panel alterzfion or extension $40.00 __ ~ <br /> <br />F. Each edditio~al Inspeetin~ <br />over the allowable in any of the <br />above, p~r Inspection $35.00 <br /> <br />G. Minor Installation Lnbels <br /> Pack d l0 labels @ $5.00 each $50.00 <br /> (~old only to d~¢trical ~ontmctors) <br /> <br />H. Other <br /> <br />5. FEES <br /> Al. Entex total of fees from Sec. #4 $ ~ <br /> A2. Add 5% surcharge (.05 x Al) <br /> Subto~ $ 5~.50 <br /> <br /> B, Enter 25% of lineAl for PlanReview <br /> (Sec. 3), if required $ <br /> C. Invemiga~ion Fee (if r~quimd) $ <br /> D. Reinspec6m Fee ($25.00) $ <br /> TOTAL A~Otm'r DYE $ 52.50 <br /> Re, ce~pr No. <br /> <br /> <br />