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MARION COUNTY BUILDING INSPECTION <br /> <br /> ~ ~[1' V~ A ~ SaI~, OR 97301 I1~: <br /> . . <br /> ~te: J D~o: ._ ~.~ <br /> I ~ ~ ~ ~~ Line ~ - <br /> , O~c~ P ne 8:~am -4:30pm <br /> <br />~T~IOAL PE~IT ~PPl IOlT~ON~ IlOf~ <br /> J ~e complete ~l ~tJons, I through 5 J 4. ~ ~CH~ (~pl~ <br /> ~ R~idmli~ P~ Unk N~bor of <br /> <br />p~ ARE NON-TRANSFERABLE AHD EXPIRE IF WORK IS NOT <br />STAETED WITHLN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />2B. FOR OWNER INSTALLATIONS <br />Property Owner (p/ease print) <br /> <br />Ma/ting Address J Phone <br /> <br />City/State/Zip <br /> <br />Owner's Signature: <br /> <br />3. PLAN REVIEW 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 />specifications with this application. <br /> <br />MC 15-341/96 <br /> <br />B. 8ervk~ or.F~ede~s (Does not include branch cir~uas, see section D) <br /> <br /> 20t ~npm to 400 amp~ $60~0 2 <br /> 401 amps to 600 amps $100.00 .. 2 <br /> 601 amps to 1000 amps $130.00 2 <br /> <br /> Remt only ,~O.00 2 <br /> <br /> 200 amp{ or less $35.00 2 <br /> 201 romps to 400 ~mps $40.00 2 <br /> 401 amps to 600 ampz $80.00 2 <br /> <br /> Eaeh branch ¢irmlit _~ SZ00 q <br /> <br /> h) The fee for branch <br /> mitchase of s~ice or fe~er fee <br /> F/mt b~ch <br />t) ~ch ad&fional ~ch o~t <br /> <br /> ~h pump ~ ~on c~io <br /> ~ si~ or outl~e li~t~ <br /> Si~ c~t(s) or a l~i~d <br /> ~el, alt~afion or ~i~ <br /> F+ ~ add~i~l l~on <br /> ~r t~ allowable ~ ~y of~e <br /> ~v~ ~ ~tion <br /> G. Min~ InMal~tion <br /> ~k of 10 labels ~ $~.~ ~ch <br /> (~d only to ~tr~l v~rr~cto~) <br /> H. 0~ <br /> <br />$40.00 2 <br />$40.00 2 <br /> <br />$35.00 <br /> <br />$50.00 <br /> <br />__¢q. fi. x $.068 =__ <br /># of Labds <br /> <br />5. FEES <br /> Al. ]~nler Imal of fe~s lmm Se~. ~ <br /> A2. Add 5% sureharg~ 605 x Al) <br /> flubtotal <br /> <br /> B, Enter 25% of line A 1 for Plan Review <br /> (See. 3), if required <br /> C. Investigation Fe~ (if required) <br /> D, Rcimpection Fee ($25.00) <br /> <br /> ~-- TOTAL AMOUNT DUB <br /> Eneeipt No. _.~'/_~o t~.~ g /' <br /> <br />$ <br />$ <br />$ <br /> <br /> <br />