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MARION COUNTY BUILDING INSPEC'FION <br />22b High Street NE <br /> Salem, Oregon 97301 <br /> <br /> Phone 58~5147 8:00 a_m,, - 4~0 p,,m. <br /> <br /> PAX: 588-7948 <br /> <br />1, LOCATION OF INSTALLA31ON <br /> <br />JobAddress S783 Shaw $.q.~are Rd <br />C~ty ~umsville , ,, Icr°ssst <br /> <br />[½~sorlptlo6: Chanqe existi3~q....serv~ tn <br /> 200A <br /> <br />2A, CON1RACTOR I~5'TALLA11ON ONLY <br /> <br />Ele~tri~l Oontractor <br /> Code Electric,Inc. <br />Mal~tng Address <br /> 2717 22nd St~. SE - Salem <br /> <br /> Property Owner <br />j Marie Greb <br /> 0ontractoes License No. 24-75C <br /> <br />"Contractor's 8oa~d Reg,, No. 19866 I Job No. <br /> <br />2B. FOR OWNER I'ISTAI.LATIONS <br />Property Owner <br /> <br />Marling Address J Phone <br /> I <br />(~'ity/Smte/Zlp <br /> <br />The In~taliatten I~ being made on property I own which is ne~ intended for sale. <br /> <br />Owner's Signature <br /> <br /> Check app/opflate item and enter f~ in ~en~n SB. ~ '~ <br />___ Conn~ ~ ~er ~ ~ps (e~pt ~le ~ ~7 I <br />~ Bui~ing sysmm ~r ~ ~ps (ex~ s~gb <br /> ,, ~s~m ~r ~0 ~1~ ~. ~ ~, <br /> Buil~ng ev~ 2 s~des ~ ~ ~ ~ ~ ~ <br /> ~il~ng ~er 10,~ ~uam ~t ~ ~ ~ ~ ' <br /> <br /> 8u~tl 2 l~te of plans wi~ any of ~e ~. .~ / <br /> Tempom~ ~ee~en s~ do <br /> <br />MC t~.4 Rev, 7/',30 <br /> <br />SITE #: Permit No. <br /> <br />Issued by: <br /> <br />4. FEE SCHEDULE (Complete end enter totel in A1 below) <br /> <br />Number a~ Inspections per permit ellowed <br /> / <br />A. Residential. Single or ~ms x COet = Total <br />Multl-Fsmlly per dvmlllng unit <br />(6~n,,~e te~udaf) <br />1500sq, ILorles~ __ $ 85.. 4 <br />Eachadd'lS00eq,,ft. orpor~on __ $ 15. __ <br />E;~.~,"h Mfg,afl Home er Medutar <br />Dwelling servJ(~e er feeder __ $ 35.. ....... 2 <br />S. Sewk:e4=eeders <br /> <br /> lOOamp~erlees -- $ ~5. -- 2 <br />"-10t ampete 400 amps '~ $ CO. 2 <br /> 401 ampsto 6ee amps $ 80. 2 <br /> 601ampslo 1000anll~ __ $150. __ 2 <br /> Over 1000 amps er volts __ $300. . .... 2 <br /> ReeennectOnly __ $ 35. __ 2 <br /> <br /> C. Tempemry Servlee~Feedere <br /> In~tallaEotl, Altera Eo~ er <br /> 2OO amps er less $ 35. __ <br /> ~Ol ampste400ampe $ 40. __ 2 <br /> 401 ampste600envps $ 80. -- 2 <br /> Over 600 amps or 1000 volts (See 4B) <br /> <br />D. Branch CIrr,.ulte <br />New, Aitera~ or Ex, tens/on Per Panel <br />One oimuit -- $ ~ 2 <br /> <br /> E~h~d'l~ci~ui~orpo~on ~ $ 15. ~ 2 <br /> <br />($~ ~ F~r no~ ~) <br />Ea~hpu~orit~a~on~cle ~ $ ~...... 2 <br />~hs~noteetllneligh~ng ~ $ ~. ~ 2 <br />Sign~ cimult(s) or a liml~ enemy <br />~el.~l~onorexten~n ~ $ ~. ~ 2 <br />F. E~ ~d'l lee~ <br />· e ~e. per In~n ~ $ ~. . <br />P~koll0~els~$5.~a~h ~ $ ~ ~ <br /> <br />~ ~er <br /> (~ ~1~ by ~i~ ~a0 <br /> <br />At. Enter teml of fees from Sec,, #4 <br />Az. Add 5% sumhaJge (,,05xA0 <br /> <br /> S~dbtot~l <br /> <br />B. Enter 25%oflineA~ for Plan Review <br /> (Sec. 3). if required <br />O. Invesdgatiee Fee (if required) <br />D,, Reinspecfion Fee ($25,00) <br /> <br /> TOTAL AMOUNT DUE <br /> Receipt N~- <br /> <br />$ 60.00 <br />$ ~ on <br />$63.00 <br /> <br /> <br />