Laserfiche WebLink
.... MARION COUNTY BUILDING INSPECTION <br />FOR crrY USE ONLY 3150 Lancaster Dr. NE - Suite C <br />Received By: Date: ~ a~ n,~ ~,~, ~,.~. Salem, Oregon 97305 <br />Zoning By: City: ', 8:00am - 4:30pm 24 HR Inspection Line 373-4427 FAX 588-7948 <br /> <br />Receipt#: Amounlc$ J AUG 3 0 1999 <br /> UARION COUN,'P/ <br /> ELECTRICAL PE, PuMIT APP~CATIO~ILDING INSPECTI( <br /> P~e coyote ~ Sec~ns, 1 t~ugh 5 <br />m <br />1. LOCA~ON OF ~LA~ON <br /> <br />Site Addmss:20167 Grim Road NE <br />city: Aurora zip: 97002 <br /> <br />mucelOwn~:North Marion School District <br />Phone: 678-5835 <br /> <br />CrossSU~t/Directions: Boones Ferry Road: hiRh <br /> <br />schopl maintenance shop <br />ProjectDeacfiption: Circuits in shop <br /> <br />PERMITS ARE NON. TRANSFERABLE AND EXPIRE IF WORE I <br />IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORE IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRAC'I'OR INFORMATION <br /> <br />Contractor: Dryden Electric ~ inc. <br />Mziling Address: PO Box 266 <br /> <br />C? Hubbard state: OR rap: 97032 <br />Phon,: 503-981-3913 <br /> <br /> c~tors ~.~d ~o.: 9~943 <br /> Contractor Liceese No.: 24-~2~C <br /> Supervisur License No.: 3138S <br /> Signature °f Supcrvising Electrician:~, ,,~1~ <br /> <br />2B. FOR OWNER INSTALLATION <br /> <br /> Property Ovnler: (please print) <br /> <br />Mailing Address: <br />City: State: Zip: <br /> <br />I am the PROPERTY OWNER and own, reside in, or will reside in <br />the completed structure and will he my own general contracto~ 1 <br />understand that I mu~t register as a construction contractor if tbc <br />structure is sold or offered for sale before or upon completion, lf l <br />hire subcontractors, I will hire only subcontractors registered with <br />the Construction Contractors Board. If I change my mind and do <br />hire a general contracwr who is registered with the Construction <br />Contractors Board. I will immediately notify Marion County of the <br />name of tha contractor <br /> <br />3. PLAN REVIEW SECTION <br /> Marion County does not require a plan review. We will provide plan I <br /> review service if you complete Section 5B and submit two (2) sets of <br /> plans and specifications wi~h tiffs application. <br /> <br />4. FEE SCHEDULE (eemplete and enter totel in A1) C/q-d72 $} <br /> <br /> Number of Insp~fous per permit allowed-- <br /> <br /> I~ ~st (e~h) Sum <br /> <br />B. ~ or F~em (~ not ~dude bm~ ~ ~ ~n D) <br /> <br /> 2~sorle~ ~ x $65.~=$ 2 <br /> <br /> Over 1~ ~ ~ voRs <br /> R~n~ly __ x $55.~=$__2 <br /> <br /> F~t ~ch c~uit <br /> <br /> ~h p~ or ~ c~le -- x $55.~ = $__ 2 <br /> E~h Si~ ~ Oufl~e ~g ~ x $55.~ = $ 2 <br /> Sig~ C~uit(s) <br /> <br /> ~TAL <br /> <br />$. FEES <br />Al. Enter total of fees from Sec. #4 $ 65.00 <br />A2. Add State Surcharge (--~r~% x A1 ) $ 4,55 <br /> SUBTOTAL $ 69.55 <br /> B. Enter 30% of llne Al for Plan Review $ __ <br /> C. Investigation Fee (if required) <br /> D. Reinspe~ion Fee ($50.00) <br /> E. Additional Plan Review ($62.50/hr. <br /> minimum one-half hour) <br /> E InspeeUon for which no fee is specifically indicated, <br /> ($62.50/hr, minimum one hour) <br /> G. Inspection Outside Normal Business Hours, <br /> ($62.50gar, minimum two hours) <br /> H. Industrial Plant ($62.50/hr) <br /> <br />TOTAL AMOUNTDUE <br /> <br />$__ <br /> <br />$ 60.55 <br /> <br />MC 15-34 Rev 9/98 <br /> <br /> <br />