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Received by: ..... <br />DateL, <br /> Phone 588-§147 8:L~0 aris - 4:3(}pm <br /> Coda-A-Phone: ~_~-V~ <br /> <br /> P/ease complete a/I Sections, 1 through1 <br /> ....... / tJ6 2 <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> 220 Higl~ Street NE <br /> Salem, Oregon 97301 <br /> <br />1. LOCA'rlot~ OF INSTALLATION ....~.~.]~R~O} <br />Job,',0ar~,, 6573 Shaw HWY SE BBILDII'~% <br />cltyAum svi 1 le J c,~,, st. <br /> <br />Directlons <br /> <br />Description <br /> <br />PERMITS ARB NON-TRANSFERABLE AND NON-F, EFUNDABLE AND <br />EXPIRE IP WORK lS NOT STARTED W1TII[N 180 DAYS OF 1SSUANCE <br />OR I~ WORK IS SUSPBNDBD FOR 180 DAYS. <br /> <br />gA. CON't'RACfOR INSTALLKF1ON ONLY <br /> <br />nl~m~.l c~...¢,o. Alltec Se~ty J Ph~03/331-262, <br />~'~*A44~"PO ~x 55310 - Portland~ OR 97238-53 <br />P~Y own~e ci 1 Preuit [P~"503/749-20 <br />~.u.=,ot', ~,e No. 26-307CIE <br />~toe. B~,,4 ~. ~o. 118839 i / ~.{ ~ob No~ 3 <br />Signature Of Su~wi~g El*ct~ci~ ~ ~ " <br /> <br /> FOR OWNER INSTALLATIONS <br />Ptol~rty Owner <br /> <br />Mailing Address Phone <br />City/State, Zip <br /> <br />The installation is bo{ns mado on proi~.ny I own which is n~ intendcd for sale, <br /> <br />.Ownets Signature ..... <br /> <br />;~, PLAN REVIEW SECTION <br /> <br /> We will provide plan review ~ervice if you complete Section <br /> 5B and submit two (2) ~ts of plato and spec~cafions with <br /> this application. <br /> <br /> This optional plan review program doe~ not suspend tho <br /> rextuir~l submission of lighting power calculations, plans, <br /> and specifications when required by the Oregon Structural <br /> Spedalty Code, Chapter 53. <br /> <br />MC 15-34 11191 <br /> <br />SITE #: <br /> <br />Permit No. <br /> <br />Date: <br /> <br /> Issued by: <br /> <br />,J~4~x~' I';E SCIIEDLILE (Complete and enter total in At below) <br /> <br /> b'uml,er of Inspections per perntil atiuwcd <br /> <br /> [.imil~d Ilnc~y -~ $20.~ 2 0 · ~0 <br /> <br /> 2(~ nmi,s or less $50.00 <br /> 201 amps to dO() amps $60.00 <br /> 40] amps to 6O(} amps $100.00 <br /> dOI ~np~ In l~;I) amp~ --~. $130.00 <br /> <br />b) '~e I~ for branch ~rculs W ~1 2U <br />Pack of lO Ia~l~ O $5.(10 each $50.00 <br /> <br />5. FEES <br /> Al. Enter total o£feca from Sec, #4 <br /> A2, Add 5% surcharge (.05 x Al) <br /> <br /> (S~. 3). if ~q~ <br /> C. lnv~tigation Fae (ffr~qu~ed) <br /> D. Re~sp~d~ Fee ($~.00) <br /> <br /> IgTAL AMO~F DUE <br /> <br />20.00 <br /> <br />$ <br />$ 21.00 <br /> <br />Recci3~ <br /> <br /> <br />