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MARION COUNTY BUILDING INSPECTION <br /> FOR CITY USE ONLY 3150 Lancaster Dr. NE - Suite C <br /> Received By: .Dat~: Salem, Oregon 97305 <br />Zoning By: . ~- ·City: 8:00am - 4:30pm 24 HR Inspection Line 373-4427 FAX 588-7948 <br />~ R~ipt~: Amount: $. } · i ~ <br /> <br /> ............................... ~-~ -- ' ' ~ 4 FEE SCHEouLE (C°mple~mad~r total In Al) <br /> <br />]ELECTRICAL PERMIt., APPLICATIONI <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />Parcel ID: <br />City: ~ Zip: <br /> <br />Phone: <br /> <br />Cross Street/Directions: <br /> <br />zs sor Sr~r~o wtr~m !SO OA~ Or ~sSv~ee o~ ff <br />WORK I~ ~USPENDED FOR I~ ~AY$~ <br /> <br />2A. CONTRACTOR INFORMATION <br /> <br /> Contractor~ .'~L) ~ ~ <br /> Cont~ct0c ~. ~ ~ <br /> <br />Property Owner: (please print) <br />Mailing Address: <br />City: State: Z~: <br /> <br />I am the PROPERTy oWNER and own, residq in or will reside in <br />the completed structure and will be my own general contractoz I <br />understand that I must register c~ a construction contractor if the <br />structure is sold or offered for sale before or upon completiot~ lf l <br />hire subcontractors, I will hire only subcontractors registered with <br />the Construction ContracWrs Board. If l change my mind and do <br />hire a general contractor who is registered with th~'Construction <br />Contractors Boatrl, I will immediately notify Marion County of the <br />rmme of the contractor. <br /> <br />Owner's Signature: <br /> <br />3. PLAN REVIEW SECTION <br /> Marion County does not require a plan renew. We will provide plan <br /> review service ify0u complete Sectiofi 5B and submit two (2) ~ets of <br /> plans and specifications with this app__. , <br /> <br />MC 15-34 Rev 9/98 <br /> <br />A.' ~ P~U~t ~ ln~: <br /> I~ ~st (~) Sum <br /> <br />L~y ~ x $~.ffi~$~1 <br /> <br /> M~ul~ Dwed~ S~i~ 0r F~er X ~2.~ = $: 2: <br /> <br /> 2~psorl~s ~ x ~.~=$ 2 <br /> <br /> ~ch ~fional ~ch c~t <br /> ~ch ~p or i~on e~ts x $55.~ = $ 2 <br /> <br /> (~ld only te EI~I <br /> <br /> O~ ~ ~qul~ by <br /> <br />5. FEES <br />Al. Enter total of: fees from Sec. ~t4 $ <br />A2. Add State Surcharge (.05% x Al) $ <br /> <br /> SUBTOTAL * <br /> <br /> B. Enter 30% ~f tine Al fo~ Pla~. Review $. <br /> C. Investigation Fee (if ~cluited) $ <br /> D. Reinspection Fee ($50.00) $ <br /> E. Additional Plan Review ($62.50/hr, <br /> mihimum one-half hour) $ <br /> F. Inspection for which no fee is specifically L~dicated; <br /> ($62.50/hr, minimum one hour) $ <br /> G. Inspection Outside Normal Business Hours, <br /> ($62.50thr, minimum two hours) <br /> H. Industrial Plant ($62.50/hr) <br /> <br />TOTAL AMOUNT DUE <br /> <br />$ <br />$ <br /> <br /> <br />