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MARI0_N..C~UNTY BUILDING INSPECTION <br /> igL'fi $rr¥ O WL?? NT <br />FOR CITY VALIDATION] s~h,~miZ~'$'Church Si NE Room 132 PERMITNO' <br />Received by: [ Q~[/_ ~*, Salem, OR 97301 ' <br /> I JUL-}0 ~.~?~ Date: <br /> ~ ,,~dv~t Inspection Line 373-4427 <br /> [~t[{l[}~] ~lll~~] }'Uone 588-5147 8:00am- 4:30pm leeuad by: <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />pERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT <br />STARTED wri~lN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />:lA. CONTRACTOR INSTALLATION ONLY <br /> <br />Sil~nature of Supervisin$ EI¢¢tricia~ <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br />Pml~rty Owner ~/etse pri~) <br /> <br />Mailing Addrezz ] Phone <br /> <br />City/Slate/Zip <br /> <br />Owner's Signature: <br /> <br />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 subreit two (2) sets of plans and <br />specifications with this application. <br /> <br />MC 15-341/96 <br /> <br /> nd eat a' tolsgin Al below) <br /> Nmnber of Inspections p~r l~nnit ~owed <br /> Rmid~ntial <br /> Unit <br />~lnclud~: lt~ C~t(~h) S~ I <br />I~ ~. · ~ less $~.~ 4 <br />~ch addit~l 5~ sq. <br /> ~ ~aion ~f $15.~ <br />~mlted ~ergy ~0,~ 1 <br />~ch Manufaem~ Hom~ or M~l~ <br /> D~lli~ ~io~ or ~ ~.~ 2 <br /> <br /> 2~ am~ or I~ $~.~ ~ 2 <br /> <br /> ~1 am~ ~ ~ ~ $1~ 2 <br /> <br /> ~r 1~ ~ps or <br /> R~nn~t only <br /> <br /> Installation. ~t~al~, ~ R~ <br /> 2~ ~ 0r le~ <br /> <br /> ~1 am~ IO ~ am~ $~.~ <br /> ~tr 6~ mn~ or 1~ vol~ <br /> <br />D. ~anoh <br /> N~, ~atiom. ~ E~n~on P~ Pand <br /> a) ~e fee for b~gh c~ui~ <br /> <br /> ~ch branch ~iguit $ 2,~ <br /> <br />$ 2.0O <br /> <br />Miacdlnn~ous (,,%rvic~ or P~d~' N~ l~lud~) <br />~ch pump ~ i~igatbn ciglo ~.~ 2 <br />~ch si~ or outline li~fing ~ ~,~ 2 <br />SignM circuit(s) or n Ihaited ~y _/ <br /> <br />a~w, ~r Impect~n $35.~ <br /> <br />Pack of 10 labe~ 0 $5.~ ~ch $~ <br /> <br /> sq. fl. x $.068 <br /># Of Labels <br /> <br />5. FEES Al. E~te, r tolal o f fees from Sec. #4 <br /> A2. Add 5% surcharge (.05 x Al) <br /> <br />Subtotal <br /> <br /> <br />