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IF'OR OFnCE U~E ONLY I MARION COUNTY BUILDING INSPECTION <br />Received by: 220 High Street NE <br />Date: Salem, O~egoa 97301 <br /> Phonc $1~B.5147 $,'00 am - 4:SOpm <br /> Code-A-Phone: 588-7904 <br /> <br /> Please complete all Sections, I througrr~o~/.~/Issued by: <br /> ..... 5 .......... <br /> <br /> 1. DOCATION OFINb'rALLATION <br /> <br /> ~&^~d,~, 144,52 ARNDT ROAD <br /> <br /> City AURORA Lcross St <br /> Dimt:tim~ ~,,OLUgB I A HELICOPTER <br /> <br /> F LO,,O O LIGHTING <br /> <br /> PERMITS ARE NON-3~ANS~ERABLB ~ NON-~E~AB~ ~ <br /> EXI>~E iF WORK IS NOT STARTED WF~ 180 DAY8 OF <br /> OR IF WORK IS SUSP~DSD FOR 180 DAYS, <br /> <br /> 2A. CO~'RA~OR INhALaTiON <br /> <br /> Ul~atC~ctor FRAHhER ELECTRIC ]~ho~ 639-4627 <br /> M~Aa~,~u 11860 SW GREENBURG <br /> ~,, ROAD [ TIGARD <br /> Pml~ny Owner <br /> Contractoes ~msC NO, 3 ~ - l 3 C <br /> Comractoe's Board Rog, NO, S 7 410 lob No. 5 5 5 31 <br /> <br /> 2B, FOR OWNER INSTALLATIONS <br /> <br /> Fm~y Owue~ <br /> <br /> City/S[ate~ip <br /> <br /> T~ i~d~n ~ ~ing ma~ ~ pro~y I own wh[~ is nm ~m~ded for <br /> <br /> O~c~* Signat~ , <br /> <br /> 3. PLAN' REneW SECTION <br /> <br /> We wilt pmvi¢e pl~ review semite if you comple~ S~fion <br /> 5B and submit two (2) sets of phns and s~ifica~on~ wi~ <br /> this application. <br /> <br /> This opdonal plan review pmg~ d~ not sus~nd ~e <br /> required submission of Hghdng ~wer calculation, <br /> an~ s~c[fieafions when require~ by the Oregon S~uatml <br /> S~ci~ty C~e, Chapter 53, <br /> <br />MC 15-34 ]1/9/ <br /> <br />Permit No. <br /> <br />~A~ON <br /> iN~,.V~:~ scnEI)ULF- <br /> ECTtON Number <br /> A. R~identlal Per <br /> <br /> ~md E~y ~ $20.00 <br /> 2~ am~ or less $50.00 <br /> <br /> b) T~ f~ f~ ~ch <br /> <br />E. Mi~c~llaneq, us (Service or I*eeeer No~ Included) <br /> Each pump or inlgation oirele ~ $40.00 ~ 2 <br /> Each ~ig. or outline lighting $40,00 __ 2 <br /> Signal cimuit(~) or a ti~ited el,~rgy <br /> panel, aheradon or exem~ioa .,, $40.00 ~., <br /> <br />F, Each additional Inspection <br />over the allowable in any of <br />abow, per Impectlon $35.00 .... <br /> <br />G, Mthor I~$t~llatioa LaNIs <br />Pack of 10 labels @ $5,00 each __ $50.00 <br />(sold only to ~l~¢Irlcal cor. tr~lctors) <br /> <br />t,I, Other <br /> f AS r~qulr~ by Buildln~ Official) .. <br /> <br />i ,ti s - " <br /> <br /> A I. Enter total o~ feea from See. ~4 $ ~ ~ ' 0 0 <br /> A2. Add 5% mmha~e (,05 x Al} ~ ~ <br /> Subtotal $ <br /> ~, ~nter 25% of I~n~ A I for Plan Review <br /> <br /> D. Roinspc~Om Fee ($25.00) $ <br /> <br />Receipt No .. __ <br /> <br /> <br />