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FOR CITY VALIDATIONI <br />Re~eiwd by: [ <br />Date: [ <br /> <br />MARION COUNTY BUILDING INSPECTION <br />COMMUNITY DEVELOPMENT CENTER <br />285 Church St NE · Room 132 <br /> Salem, OR 97301 <br /> <br /> =LgGFRIOAL PE Yff APPLIOA'HON <br />P/ease complete all ,~ections, I through <br /> <br />1. LOCATION OF ENSTALLATION <br /> <br /> ~4 hr. Inspection Lina 373-4427 <br />Office: Phone 588~147 8:00am - 4:30pm <br />FA~: 588-7948 <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT <br />STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR IS0 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION OHLY <br /> <br />I <br /> <br />FOR OWNBR INSTALLATIONS <br /> <br />Property Owner (ple~m~ pri~) <br />Mailing Address ] Phone <br />City/State/Zip <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 two (2) sets of plans and <br />specifications with this application. <br /> <br /> 'p' '5' 199 <br /> / <br /> <br />Date: BUILDING INSPECTION <br /> <br />Issued by: <br /> <br />4. FEB $CHtK)ULE (Complete arid enter tolal in Al below) <br /> <br /> R~d~ti~l <br /> Unit <br /> ~[n~d~: It~ C~t (each) Sm <br />1~ sq. ~ ~ less $85.~ 4 <br /> <br />~ Manufactu~ Home or Modular <br />DwelI~ Se~ice or ~eder ~.~ ~ 2 <br /> <br />Co <br /> <br />200 amps or le~s $35.OO <br />201 amps to 400 aml~ $40.00 <br />401 amps to 600 amp~ $80.00 <br /> <br /> b) The fee for branch circuits without <br /> <br /> Fw~t branch oh'cint <br /> Each additional branch cimu/t <br /> <br />-.,B; ' Mise~llanaona (~vice ~r peeder N~ Included) <br /> Each pump ~ in/gati0n circle [. <br /> Each sign or outline lighting <br /> Signal ¢ir~ugia) or a limited energy <br /> panel, altexatlon or exlemion <br /> F. Each additional i~spection <br /> Over the allowable in any of <br /> above, per In~pectlon <br /> G. Min~r Installation Labels <br /> Pack o£ 10 labels @ $5.OO each <br /> (sold only to electrical co~tra~tors) <br /> H. Other <br /> (A~ tvquired by Building OtTwisD <br /> Aurora Dwelling Ela~trical Fg <br /> Dwelling Permit Label <br /> <br />$35.OO <br />$ 2.00 <br /> <br />$4O.00 <br /> <br />$40.00 <br /> <br />$35.110 <br /> <br />$50.00 <br /> <br /> .,_sq. fi. x $.068 ~ -- <br />#oft.abes <br /> <br />N/C <br /> <br />5. FEES <br /> <br />Subtotal <br /> <br />B. Enter 25% of line A 1 for plan Review <br /> (Sec, 3), if r~quired <br />C. Investigation Fee (ff required) <br />D. Rcimpeetion Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br /> Receipt No, <br /> <br />$ Z~-- <br />$ <br /> <br /> <br />