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MARION COUNTY BUILDING INSPECTION <br />COMMUNITY DF~VELOPMENT CENTER <br /> <br /> 285 Chu~h St NE' Room 132 PERMIT NO: <br />FOR <br /> CITY <br /> VALIDATION <br /> Sal~, OR 97301 " <br />R~ived by: ...... <br />~are: ~ Hr l~t~n Lht~ 58~7~ <br /> F~: 58~9~ Issu~ by: <br /> <br />Ple~e complete ~1 Section,s, I through 5 [ 4. FEE SCHemE (Complete and onto' ~tel in A 1 below) <br /> <br />Dgscdptlon <br /> <br />PERMITS ARI/[ NON-TRANSFERABLE AND EXPIR~ IF WORK IS NOT <br />STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR IS0 DAYS. <br /> <br />CONTRACTOR INSTALLATION OlqL¥ <br /> <br />Supervisor+ti License No, I Phone <br /> <br />3. PLANRIiVIEW 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 />spec'fications with this application. <br /> <br />MC Zf-.$d 12L04 <br /> <br />~0 ampa or less ,,TZX_ $50.00 <br />601 amps to 1000 amps $130.00 <br /> <br />201 am~ to ~0 amps $~-00 <br />~er ~0 m~ps or 10~ ~olm <br /> <br /> Signal cimuit(s) or a limited en~gy <br /> <br />H, Oth~- <br /> (As req~#ced by Boilding or, ciaO <br /> <br />$35,00 <br />s 2.00 <br /> <br />$40,00 ~ 2 <br />$40,00 ---- 2 <br /> <br />$40.00 , 2 <br /> <br />$35,00 -- <br /> <br />$50.00 <br /> <br /> ~l. g, x $,06 = <br /># Of Labels _H/C . <br /> <br />' 5, FEES <br /> Al, Enter total of fees fro/Il Sec, #4 <br /> AZ, Add 5% sureharg* (,05 x Al) <br /> aubtota] <br /> <br /> B, Enter25% oflln*Al forPlanRevlew <br /> (See, 3), if ~quited <br /> C, InvcaSgation Fee (if requ}~d) <br /> D. Relmpe¢tion Fee ($25.~) <br /> <br /> TOT~ ~OU~ DUE <br /> Receipl Ho. ~,,, <br /> <br /> <br />