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i'~OR OFFICE USE ONLY INSPECTION <br /> MARION <br /> COUNTY <br /> BUILDING <br /> c <br /> Received by: 220 High Street NE <br /> <br /> Date: <br /> Salem, Omgrm 97301 <br /> <br /> ~-n.~: 588-7~4 <br /> , F~; S~-79~ . ,~ .... <br /> <br />I I' =;: <br /> L ~a'rlo~ O~ IN~ALLATION 4, ~E $CHED~ (C~pl~ ~d ~te~ t~l m AI ~low) <br /> <br />PERMITS ARE NON-TRANSI~KABLE AND NON-RBFUNDABLE AND <br />EXPI~[B IF WORK IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE <br />OR ~ WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A, CONTRACTOR INb~fALLATION ONLY <br /> <br /> Service Included: <br /> <br />1003 sq. fk or less $85,00 <br />Each additiaaa1500 s~, ft, <br />~ffi~ ~cm~ $15.00 <br /> <br />E~h Manufd Home or <br /> Dwe~ng Se~i~ or F~der <br /> <br />B. Servl~ or ~e~ors ~, not ~l~de branch m rc~t~, <br /> Ins~lation~AIt~aOons~Rel~atlon i <br /> ~ amps ~lcsa / $50,00 <br /> ~1 am~ ~ ~ ~ps _ $60.00 <br /> <br /> ~1 am~ m 1~ amps $~80.00 <br /> ~r 1~ ~pa or volts $~00.~ <br /> R~t rely $40.00 <br /> <br /> 2~ ~ps or less ~ $35,00 <br /> 201 ~p~ to 4~ ampa $40,00 <br /> <br /> Bach brach c~uit <br /> <br />b) ~e f~ [~ bm~ch dmm~ wi~out <br /> ~rcha~e 9f ~icc or feeder <br /> <br />/ $ .oo O.av <br /> <br />Pr~peay Owner <br /> <br />Mailing Address Phone <br /> <br />City/StatefZip <br /> <br />PLaN REVIEW SECTION <br /> <br />$35.m> <br /> $2.00 <br /> <br />E, Miscellaneous (Service or Feeder Not Included) <br /> Bach ~amp c~ irrigation circl~ $40,00 2 <br /> Each fi~ or ~e hgh~g ~ $40,00 2 <br /> S~n~ c~uiff~) or a ~ted ~e~y <br /> ~nel, ~teration ~ ~tmsim $40.00 ~ 2 <br /> <br /> ~er ~e ~owable ~ any of ~ <br /> a~, ~r Inspection $35.00 <br /> <br /> Pack of 10 la~Is (~ $5.~ each .... $50,00 <br /> <br />H, Other <br /> ( A,e ~q~r¢d by Buildia8 0ffic~I) <br /> <br />Wc 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 doe.~ not suspend the <br />rCqnirecl submission of lighting power calculations, plans, <br />and specifications when required by the Oregon Structuxal <br />Specialty Code, Chapter 53. <br /> <br />MC 15-34 11/91 <br /> <br />5. FEES <br /> Al. F~t*r t, oval of fcea from Sec. #4 <br /> A2, Add 5% ~urcharge (.05 x A 1) <br /> <br /> Submtal <br /> <br /> It. Enmr 25% of llne Al ~or Plan Review <br /> (S~, 3). if mqalmd <br /> C, I~vcsfigation Fee (if required) <br /> D. Rcln~pection Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br /> <br /> P,c~ip~ No ..... <br /> <br /> <br />