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OFRCE USE ONLY <br />Received by: <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION ,~-'~ <br /> <br /> "Salem, Oregon 97301 <br /> Phonc 588-5147 8:00 a.m. - 4:30 p.m. ,F'~!'£! <br /> Code-A-Phone: 588-7904 8TE#' Pern~ t N~o <br /> FAX: ,~s-79~ ' ,~,~ ~ ~, ,, ' .... <br /> Date <br /> <br />2B. FOR OWNER ~STALLATIONS <br />Mailing Address <br /> <br />City/State/Zip <br /> <br />Phone <br /> <br />The installation is being made on property I ~wn which Is not intended for sale, <br />}ease or rent. <br /> <br />Owner's Signature <br /> <br />3, PLAN REVIEW SECI1ON <br /> Check appropriate item and enter fee in SanSon 5B. <br /> <br />__ Connected Load over 200 amps (except single family dwellings) <br /> BuiU1ng syatem over 200 amps (except slngte family dwellings) <br /> System over 600 volts <br />__ Building over 2 erodes <br /> Build,ne over 10,000 equine feet <br />__ Co~zpent load over 300 persons <br />__ Manufa=tumd Dwelling P~n Pad< <br /> Hazardous Locations <br /> <br />Submit 2 sets of plans with any of the above. <br />Temporary conetruc'~ion services do not apply, <br /> <br />Iseued by: <br /> <br />4. FEE SCHEDULE (Complete and enter total in A~ below) <br />Number of Inspections per permit allowed <br /> <br />A. Residential, Slngteer <br />Multi-Family per dwsillng unit <br />($erv.~e it~=luded) <br /> <br /> 1500 sq. h. ~less <br /> E~h add!1500 ~1- ft. or porlten <br /> Each Mfg.'d Horne or Mo~ler <br /> Dwelling santice ~ feeder <br /> <br />B. '=e~vl~e/Feeders <br />(10 Brw~h Glr ~/i~ k~eded) <br /> <br /> 101~ete~ <br /> ~1 ~sfo ~ ~ <br /> ~1~10~ <br /> ~ 1~0 ~ o~ ~1~ <br /> <br />D. Branch Circuits <br />Ne-w, Ai~m~o~ or Extanslo~ Per pane/ <br /> One clmult <br /> T~ ~n ~r~i~ <br /> E~ ~1 ~n cl~i~ or po~on <br /> <br />~ ~s~lnneous <br /> <br /> E~h pu~ or Itdga~ce ~le <br /> E~h s~n or outline ligh[ng <br /> SlgnN cimult(e) et a I1~ <br /> <br />F, ~=h edd'l Ins~=Uon <br /> ~ the ~le in any ~ <br /> · e ~e, per In~on <br /> <br />G. MIn~ Inc~lle8ee <br /> P~kof 10 I~ ~ $5.~ e~h <br /> <br />~ ~r <br /> <br />At. Enter to~ of fees from <br />A~. Add 6% smcharge (.05xAt) <br /> <br /> Subtotal <br /> <br />B. Eofer 2.5% of line A1 for Plar~.Review <br /> (Sec. 3), if required <br />C. Inveslfgaltee Fee (if required) <br />D. Reinspe~on F~e ($25.0O) ~ <br /> <br />TOTAL AMOUNT DUE <br /> <br />Receipt No. <br /> <br /> / <br />Items x Coat = Totel ~, <br /> <br />__, $ ,~, __ 4 <br />$ 15. <br /> <br /> 2 <br /> <br />__$35.__ <br /> <br />Pease ~ a~ ,.~ct/ons, ~ ~'~ugh 5 <br /> <br /> <br />