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MARION COUNTY <br /> FOR CITY VALIDATION BUILDING INSPECTION DIVISION PERMIT NO: <br /> I 3150 Lancaster Dr. NE - Suite C <br /> Received By: __ Salem, Oregon 97305-1398 Date: <br />[Date: __ Z4 HR l~Sl~Cfioa L~ 373-4427 <br /> I Off')ce: p~ - 4:30pm Issued by: <br /> <br /> P/ease complete ali Sections, I through 5 ~ 40~ [~ ~§ ~ rJ (complete ,,~ e,,~r to~l ~ ^l ~ow) <br /> Number of Insln~tions p~r p~tmit allowed <br /> Residential Per Unit <br /> MARION COUI ~YService [nduded: Items Coat (each) $.m <br /> <br />1. LOCATION OF INSTALLATION BUILDING INSPI <br /> T"ACCO NO'I I I I I I--I I I <br /> <br /> .°NE I 101 1-1 I I I /I <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT [ <br /> STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> [ <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />2B. FOR OWNER INSTALLATIONS <br />tProperty Owne~r(please prinO <br /> <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 7/97 <br /> <br />[~N R. or less $85.00 <br />Each additional 500 sq. fi. <br /> or portion thereof $15.00 <br />Limited Energy <br />Each Manufactured Home or <br />Modular Dwelling Ser~e or Feeder $40.00 <br /> <br /> B. Services or Fe~ders (Does not include branch circuits, see section D) <br /> <br />200 amps or less $50.00 __ 2 <br />201 amps to 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 volta $300.00 __ 2 <br />Reconnect only $40.00 __ 2 <br /> <br />Each sign or~uilin~ lighting .... $40.00 2 <br /> <br />5. FEES <br />A I. Enter total of fees from Sec. ~4 $ <br />A2. Add 5% surcharge (.05 x Al) $ <br /> Subto~ $ <br /> <br />B. Enter 25% of line Al for Plan Review <br /> (Sec. 3), if required <br />C. Investigation Fee (if required) <br />D. R~inspeclion Fee ($25.CO) <br /> <br />Receipl No. <br /> <br />TOTAL AMOUNT DUE <br /> <br /> <br />