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FOR CITY VALIDATION <br />R~eiv~d by: <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> 285 Church St NE · Room 132 <br /> Salem, OR 97301 <br /> <br />PERMIT NO: <br />Date: <br /> <br /> 24 Hr Inspeotloa Line: 588~7904 <br /> Office: 588-5147 8:00 a.m. - 4:30 p.m. <br /> ~'~'N,"'~ .FAX.: ~88-7948 , Issued by: <br /> <br /> Please <br /> complete <br /> all <br /> Sec#ons, <br /> 1 <br /> ,llroug~[~-[~,-~ ~ S~.~II~DUL~ (Completa and elam' tots, in A1 below) <br /> ---- SEla "' 5 V;q7 ~ Nmnber°fInsp~cti°nsporpermitall°wed~] <br /> "A.° Residential Pe~ Unit <br />1. LOC ATION OF INSTALLATION Set vice lnoluded: Items Cost (each) Sum <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT I <br /> STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />:lA. COIN'TRACTOR INSTALLATION ONLY <br /> <br />EleetricalContraetorEC/Litmeo Elec. ] Phone 926-4266 <br />Mailing Address P 0 ~OX 925 <br /> <br />Property O~n~r Will~tte Seed CO. ] P~ne <br /> 769-2330 <br /> <br />Contractor's License No. 22-15C <br /> <br />Contractor's Board Reg. No. 49737 <br /> <br />Signature of Supervising Elec~cian <br /> <br />Ione926'-4266 <br /> <br />0[ <br />~P <br /> <br />Supervisor's License No. 3257S <br /> <br />2B. FOR OWNBR INSTALLATIONS <br /> <br />Pmper~ Owner ~pleas~ print) <br /> <br />Mailing Address <br /> <br />I Phone <br /> <br />City/StateJZip <br /> <br />Owner's Signature: <br /> <br />3. PLAN RBVIBW 8BCTION <br /> <br />~sq. ft. or less $85.00 4 <br /> addiliona1500 sq. ft. <br />!CTION or portion thereof $15.00 <br />Limited Energy $20.00 [ <br />Each Manufactured H~qle or Modular <br /> Dwelling Service or Fe~der $40.00 -- 2 <br /> <br /> B. Se~vic~ or Feed~s (Does not include branch circuits, see section D) <br /> <br />Installation, Alteration or Relocation <br />200 amps or less <br />201 amps to 400 amps <br /> <br />1 $50.00 50'002 <br /> $60.0O 2 <br /> $100,00 __2 <br /> $130.00 -- 2 <br /> $.300.0O -- 2 <br /> $40.00 2 <br /> <br />$35.00 2 <br />$40.00 2 <br />$80.00 2 <br /> <br />$ 2.00 -- <br /> <br />$35.00 -- <br />$ 2.00 -- <br /> <br />E. Miscellaneous (Servioo or Feede~ Not Included) <br />Each pump or i~gation ci~le $~.00 -- 2 <br /> ~eh si~ or outline light~g ~.~ 2 <br /> Sign~ circuit(s) ora ~it~ envy <br /> panel, alt~ati~ or ex~mion ~.~ ~ 2 <br /> <br />Over ~e allowable in any of~e <br />above, per Insp~tion $35.~ -- <br />G. Min~ In~aHation Labols <br />Pack of 10 labMs ~ $5.~ ~ch $~.~ <br />(sold only to el~trical comractors) <br /> <br /> (~ r~uiced by ~itdi~ O~tci~D <br /> Aumra ~elling Elec~cal F6¢ __.~. · x$~ = __ <br /> Dwelling Permit ~bel ff of ~bels, NIC <br /> <br />5. FEES <br />Al. EntertotaloffeesfmmSec.#4 $ 5:/~ <br />A2. Add 5% surcharge (.05 x Al) $. <br /> 8abto~al $.__ <br /> <br /> B. ~ter 25% of line Al for Plan Review <br /> (Sec. 3), if r~uigd $.~ <br /> C. ~vestigation Fee (if req~r~) $ <br /> D. Reimpection Fee ($25.~) $ <br /> <br /> ~T~ ~OU~ D~ $ 56 _ 70 <br /> Receipt No. <br /> <br />Marion County does not require a plan review. <br />We will provide plan review sen, ice if you complete <br />Section 5B and submit two (2) sets of plans and <br />specifications with this application. <br /> <br />MC 15-34 12/94 <br /> <br /> <br />