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- M.k~dt~R~rrs SmLDINGmSPEC?ZON <br /> [~[~M[~TY DEVEL~O. PMENT CENTER <br /> ~u~h St NE R~m 1~2 <br /> FOR CITY V~IDATION[ - S~em OR 97301 PERM~ NO: <br />{~: I JAN 1 4 ~99~' <br /> ~ ' ~1~ D~e: <br /> Date: [ ~~ ___ ~ ~nspecti°n Line 37~427 <br /> <br /> ~ R~ldemlal P~ Unit Nmnb~ <br /> I. LOCATION OF ~LATION <br /> <br />I~.RMrr s ARE NOH-TRANSFi~RAELE AND F. XPII~ IF WORK IS NOT <br />STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br /> CONTRACTOR INSTALLATION ONLY <br /> sl*~u4*ale°nu~°m~SELECT ELECTRIC { mo., 371-0896 <br />I mi""~AU~'~'Ll7q2 LIBERW RD S #2LI2,SALEM 97-502 <br /> <br /> C°"lract° r'" Lie~" e l"r°' 2q--281C <br /> Con~.c,or's Bo,rd ~e~. ~o, 83521 I t® ~°/'~ ,, <br /> <br />~..~,lsor'. ~i.n.,,, ,,"°' .2782S "~ T/1-0~ <br /> <br />2B. FOR OWNER INSTALLATIONS <br />Pco~rty Owner (ple~s~ ;rinO <br /> <br />M~ilin~ Addre~ I Phone <br />City/Sate,Zip <br />Owner's Signature: <br /> <br />3. PLA.N RBVIEW 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 ~o (1) sets of phns and <br />specifications with this application. <br /> <br />MC 15-34 1/96 <br /> <br />S~rviee Inoluded: <br />1000 sq. fi, ~ le~ $85.00 4 <br />~ addiional 5~ sq. fl, <br /> ~ ~n ~f $15.~ <br /> <br />~ch Manufactu~ Home or Modul~ <br />~elling ~ice or Feed~ ~0,~ 2 <br /> <br />B. 8~vi~ ~ P~a (~ea not ~elude branch ei~ui~ ~ s~n D) <br /> <br /> ~ amps or Ica $~.~ 2 <br /> 201 am~ m ~ am~ $~.~ 2 <br /> <br /> ~1 ~ps to 1~ ~ $130.~ 2 <br /> <br /> 2~ ~ or le~ $35.~ 2 <br /> 201 ~ ~o ~ ~ ~.~ 2 <br /> <br /> a) ~e fee for b~eh e~ui~ ~ <br /> . <br /> <br /> b) The fee for branoh cit~uila ~ <br /> <br />E. Miscellaneous (Servlee cr Feed~ Nei Ineluded) <br /> <br /> Pack of I0 labels @ $5.00 each <br /> <br /> (As required by Building OlNcial) <br /> <br />$ 2.~ <br /> <br />$35.00 <br /> <br />$50.00 <br /> <br /> ,*q, fl. x$,068=__ <br /># of l.nbels, <br /> <br />FEE8 <br />Al. Enter total of fee~ fiom Se~. tel <br />A2. Add 5% sur*harge (.05 x Al) <br /> <br />~ubtotal <br /> <br />B. Enter 25% of line Al for Plan Review <br /> (Sec. 3), if required <br />C. Investigation Fee (ifrequlred) <br />D. Reinsp*¢tlon Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br /> Receipt No, <br /> <br /> <br />