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FOR CITY USE ONLY <br />Received By: Date: <br />Zoning By: City: <br />Receipt ~ <br /> =Amount: $ ~ k,~ ~'/ .... <br /> <br /> Iteraz ~ (~h) Sum <br /> <br /> MARION COUNTY BUILDING INSPECTION <br /> 3150 Lancaster Dr. NE - Suite C <br /> Salem, Oregon 97305 <br />4:30pm 24 HR Inspection Line 373-4427 FAX 588-7948 <br /> <br />!. LOCATION OF INSTALLATION <br /> <br /> Parcel ID: <br /> <br /> si~d~ss: 20167 Grim Road NE <br /> <br /> City: Aurora Zip: 97002 <br /> <br /> mm:elOva~: North Marion School District <br /> ~o~: 503-678-5835 <br /> <br />OossSm~/Di*e~io~: Boonms Ferry Road <br /> <br />North Marion vocational/ag building <br />Pro~aD~q~om Circuits for a~ deoart~nt <br /> <br />PERMI~ ARE NON. TRANSFERABLE AND EXPIRE 1F WORK <br /> <br />IS NO~ STARI~D WI~HIN 1~0 DAYS OF ISSUANCE OR IF <br />WORK i$ SL~PENDED FOR 180 DAY~ <br /> <br />~ CONTRACI~R INFORMATION <br /> <br />co~aoc Dryden Electric, Inc. <br />M"m"S'na'a~SS:po Box 266, <br />Gm: Hubbard sm~: OR mp: 97032 <br /> <br />Pho~: 503-981-3913 <br /> <br />Contraa~ Bo~ ~o.: 98943 <br />CoaL~t~ Uc~ ~o.: 24-322C <br />S.p~-~i~r Li~a~ l, lo.: 3138S <br /> <br /> Signatme of Supendsing ~ician: ,'~'~k. <br /> <br />~B. FOR O~R ~AL~ON <br /> <br /> ~ ~ ~e~e p~) <br /> <br />Mailing Address: <br />City: State: Zip: <br /> <br />1 am the PROPERTY OWNER and own, reside in, or will reside in <br />the completed structure and will he my own general contractor. I <br />understand that I must register as a coastruction contractor if the <br />structure is told or offered for sale before or upon comptetiott If I <br />hire subcontractors, I will hire only subcontractors registered with <br />the Construction Contractors Board. If l change my mind and do <br />hire a general contractor who is registered with the Construction <br />Contractor~ Boar~ I will immextiately notify Marion County of the <br />name of the contractor. <br /> <br /> Owner's Signature: <br /> <br />3. PLAN REVIEW SECTION <br /> <br />5. FEES <br /> Al. Enter total of fees from Sec. g4 <br /> A2. Add State Surcharge (-t15% x Al) <br /> ,,ak <br /> <br />SUBTOTAL <br /> <br />B. Enter 30% of line A 1 for Plan Review <br />C. Investigation Fee (if required) <br />D. Re:inspection 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 /> ($62.50/hr, minimum two hours) <br />H. Industrial Plant ($62.50fnr) <br /> <br />TOTAL AMOUNTDUE <br /> <br />Marion County does not requLre a plan review. We will provide plan <br />review service if yoU complete Section 5B and submit two (2) sets of <br />p aas and specLfieat oas with ~his application. <br /> <br /> 77.00 <br /> 5.29 <br /> <br />$__ <br />$__ <br />$__ <br /> <br />$__ <br /> <br />$__ <br />$__ <br /> 82.39 <br /> <br />MC 15-~4 I~v 9/98 <br /> <br /> <br />