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i FOR CITY USE ONLY Received By: .Date: Zoning By: City: Receip~ ~ Amount: S. MARION COUNTY BUILDING INSPECTION 3150 Lancaster Dr. NE - Suite C Salem, Oregon 97305 8:00am - 4:30pm 24 HR Inspection Line 373-4427 FAX 588-7948 .... ' 4. FEE SCHEDULE (complete and enter total in Al) Please complete all Sections, I through $ ~, Residential Per Unit S~r~tee Included: Items Coat (each) Sum q(~ 6q~q[i ~ 1000sq. fx. orless __ x $110.00=$__ L LOCATION OF I~STALLATION ~ ~eh ~dditiona1500 sq. t~. or pmXion thereof -- x $20.00 = $__ City: ~4~,~ [~__.~ 5' --J' - - ~'.lm~ltl~m, Alteration or Relocation ~ 2 2 2 2 2 2 __2 2 $__ $__ $ $__ $__ $ $__ 200 amps or less 201 amps to 400 amps -- x $80.00 = $ .... 601 ampsto 1000amps -- x $170.00=$ Cross Stroel/DLrections: Over 1000 amps k ~ Reconn~t Only -- x $55.00 = $ C. Temporary Servic~Feeders (1 ll'~thllatton, Alterations, or Relocation Project Description: ~-~ - 201amps w 400 amp~ -- x $55.00=$ pERMITS ARE NON. TP,,ANSFERABLE AND EXPIRE IF WOPJ( ] --- 401 amps to 600 amps -- x $110.00 = $ IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE OR IF Over 600 amps or 1000 volts see "B" above WORK IS SUSPENDED FOR 180 DAY& D. Bnmeh Circuits a) The fee for branch circuits with the 2A. CONTRACTOR INFOIOgATION ourcha~e of Service or Feeder Fee: Contractor: Each branch circuit __ x $3.00 = $ b) The fee fo~ branch ¢ilcuits without the IMailillg Address: mtrcha~ of Service or Feeder Fee: First branch circuit ._L~x City: State: Z~p: Each additional branch cin:tht _~..~_ Nv-~ $3.00 = $ E. Mlseelloneous (Service or Feeder Not Included) Phone: Each pamp or irrigation circle -- x $55.00 = $ Eaeh$ignorOntlineLisflting -- x $55.00=$ Fox: Signal Circuit(s) ~ a Limited F.~ex~gy Panel, Alt~afion ~' Extension -- x $55.00 = $ :~tractors Board No.: F. Each addltlonni lnsl~tion ',ontract~' License No.: over the allowable in any of the above, per inspoellon -- x $50.00 = $ upervisor License No.: G. Minor Inslnilaflon Lni~-te Pack Signatu~ of Supervising Electrician: (Sold only to Electrical Contractors) H. Industrial Plant -- x $62.50~r = $ 2B. FOR OWNER INSTALlaTION Onetrwo Family Dwelling F~: ~ope~ own= (pleas~ vdnO tf~ ~ ], /~ ~ S n/ n~, O~el~., Par. at ~ ~'or S~.Ze rana~y ~dth, o O.ly) OTHER, a~ required by the BulldOg Offielal I am the PROPERTY OWNER and own, reside in, or will reside in $. FEES the completed structure and will be my own general contractor. I Al. Enter total of fees from See. #4 understand that I must register az a construction contractor ~f the A2. Add State Surcharge (,05% x Al) structure is sold or offered for sale before or upon completiotr lf l hire subcontractors, I will hire only subcontractors registered with $ L~B TOTAL the Construction Contractors Board. Ill change my m/nd and do B. Enter 30% of line A1 for Plan Review hire a general contractor who is registered with the Construction C. Investigation F~ (if reqnit~d) Contractors Board, I will immediately notify Marion County of the D. Reinspection Fee ($50.00) name of the contractor Ownex's Sigeeture: /~~ ,----------'1 E. Additional Plan Review ($62.50/hr,minimum one-half hour) · \ I F. Inspection for which no fee is specifically indicated, 3. PLAN REVIEW SECIION )--~/ ($62,50/hr. minimum one hour) G. Inspection Outside Normal Business Hours, Marion County does not require a plan review. We will provide plan I ($62,50/hr, minimum two hours) review service if you complete Section 5B and submit two (2) sets of p aris and sl~cifications w th this application. H. Industrial Plant ($62.50&r) TO~AL AMOUNT DUE MC 15-34 Rev 9/98