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..................................... MARION COUNTY BUILDING INSPECTION <br />! FOR C~I~FY USE ONLY 3150 Lancaster Dr. NE - Sui~ C <br /> <br />: Zoning By:. _City: a - 4:30pm 24 HR Inspection Line 3734427 FAX 588-7948 <br /> <br /> Receipt #: Amount: $. <br /> 4. FEE SCHEDULE (complete and enter total in Al) <br /> <br /> Please complete all Sections, lthrough5 laa 10. <br /> <br />1. LOCATION OF I~STALLATION <br /> <br />Parcel ID: <br /> <br /> g ? ff'- l-/,21b <br />Cms~ $ ~-ee~/Direetions: <br /> <br /> YlttJ ~tlled <br />PE~ ~ NON-T~SFE~ ~D E~I~ IF WO~ <br /> IS NOT ST~T~ ~IN 1~ DAYS OF ISSU~CE OR IF <br /> WO~ IS SUSPE~ FOR 1~ DAY~ <br /> <br />CONTRACTOR INFORMATION <br /> <br /> Items C.o~t (each) Sum <br /> <br />Each additional 500 sq. fL or portion thereof -- x $2~.00 = $ -- <br />Each Manufaclmed Horae or <br /> <br /> 2o, ~o~OO.,,,P' x s~e.oo =s 2 <br /> <br />...... E. MisceHaneousfServtceor Feeder Not lndud~l) ~ ~O <br /> Eachpumporini~tioncitclc ~ - X--~5.00~'~_2 <br /> <br /> Supervisor License NO.: <br /> <br />2B. FOR OWNER INSTALLATION <br /> <br />Progeny Ownec (please print) <br />Mailing Address: <br />Cliy: Sate: Zip: <br /> <br />I am the PROPERTY OWNER and own, reside in, or will re, ldo in <br />the completed structure and will be my own general contractor. I <br />understand that I must register as a construction contractor if the <br />structure is sold or offered for sale before or upon complet~or~ lf l <br />hire subcontractors, I will hire only subcontractors registered with <br />the Construction Contractors Boar~ If I change my mind and do <br />hire a general contractor who is registered with the Construction <br />Contractors Board, I will immediately notify Marion County of the <br />name of the contractor. <br /> <br /> ,Owner's Signature: <br /> <br />3. PLAN REVIEW SECTION <br /> <br /> Madoa County does not require a plan review. We will provide plan <br /> review service if you complete Section 5B and submit two (2) sets of <br /> plans and specifications with this applica6oa. <br /> <br />MC 15-34 Rev 9/98 <br /> <br />F. <br /> <br />F~:h Sign cc Outliae Lighting -- x $55.00=$__2 <br />Signal Circuit(s) or a Limited Enerl~ <br />Panel, Altenfion o~ Extension -- x $55.00 = $ -- 2 <br />Each additional lnslnction <br />over the allowable In any of the <br /> <br />5. FEES Al. Enter total of fees from Sec. g4 <br /> <br /> A2. Add State Surcharge (.05% x Al) <br /> <br />SUBTOTAL <br /> <br />B. En~r 30% of line Al for Plan Review <br />C. Investigation Fee (if required) <br />D. Reinspection Fee ($50.00) <br />E. Additional Plan Review ($62.50/hr, <br /> minimum one-half hour) <br />F. Inspection for which no fee is specifically indicated, <br /> ($62.50/hr, minimum one hour) <br />G. Inspection Outside Normal Business Hours, <br /> ($62.50far, minimum two hours) <br />H. Industrial Plant ($62.50/hr) <br /> <br />TOTAL AMOUNT DUE <br /> <br /> <br />