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..................................... ~ MARION COUNTY BUILDING INSPECTION FOR CITY USE ONLY ! ,~¥ '~ , 3150 Lancaster Dr. NE - Suite C Received By: Date: '~ ""-~ ~ .......... ' Salem. Oregon 97305 Zoning By: City: ' 8~00am - 4:30pm 24 HR Inspection Line 373-4427 FAX 588-7948 [Receipt#: Amount:$ , ~? ~'] {~/~ Please complet~ all Sections, 1 through 5 I 1. LOCATION OF INSTALLATION City: ~ Zip: Cross Street/DireCtions: PERMI~ ARE NON. TRANSFERABLE AND EXPIRE IF WORK ts NOr StARrED WITItlN 180 DAYS OF ISSUANCE OR IF WORK IS SUSPENDED FOR 180 DAYS. 2A. CON~RAC.TOR INFORMATION Supervisor License No.: Signature of Supervising 2B. FOR OWNER INSTALLATION Property Owner: (please print) - Mailing Address: City: State; Zip: I am th~ PROPERTY OWNER andown, reside in, or will reside in the completed ~tructure and will be my own general contractor. 1 understand that I must register a* a con*truction contractor if the structure is sold or offered for sale before or upon completior~ lf l hire subcontractors, I will hire only subcontractors registered with the Construction Contractors Board..If [ change my mind and do hire a general contractor who is registered with the Construction Co~tractors Board, I wet immediately notify Marion County of the name of ~hq contractor. Owner's Signature: 3. PLAN REVIEW SECTION Marion County does not require a plan re{'iew. We will provide plan review service if you complete Section 5B and submit two (2) sets of plans and specifications with this application. MC 15-34 Rev 9/98 4. FEE SCHEDULE (complete and enter total in Al) Number of Inspections per permit allowed Residential Per Unit Set,dee Included: 1000 sq. ft. or less Each additional 500 sq. ft. or potion thereof -- Limited Energy Each Manufactured Home or Modular Dwelling Semite or Feeder Items Coat (each) x $20.00=$__ -- x $30.00=$__ Sam __ x $52.00=$__2 Services or Feeders (Does not include branch Circuits, see section D) -- x $65.00=$t_t'~.O,O~2 __ x $80.00=$ 2 -- x $130.00 =$ 2 __ x $170.00=$ 2 __ x $390.00 = $ __ 2 -- x $55.00=$~2 $45.60=$__2 $55,00 = $ 2 $110.00=$__2 -- x $3.00:$ ~0-00 -- x $50.00=$__ __ x $3.00=$__ -- x $55.00=$ 2 -- x $55.00=$__2 Installation, Alteration or Relocation 200 amps or less [ 201 amps to 400 amps 401 amps to 600 amps 601 amps to 1000 amps 401 amps ~ 600 amps a) The fee for bra~ch circuits with the Signal Circuit(s) or a Limited Energy F. Each additional Inspt~ion above, per inspection TOTAL SUBTOTAL FEES Al. Enter total of fees from Sec. 04 A2. Add State Surcharge (.05% x Al) B. Enter 30% of line A 1 for Plan Review C. Investigation Fee (if requi~d) D. Reinspecfion Fee ($50.00) E. Additional Plan Review ($62.50/hr, minimum one-half hour) F. Inspection for which no fee is specifically indicated, ($62.50/hr, minimum one hour) G. Inspecfion Outside Normal Business Hours, ($62.50/hr, minimum two hours) H. Industrial plant ($62.50/hr) TOTAL AMOUNT DUE __ x $55.00=$ 2 -- x $50.00=$__ __ x $100.00=$__ -- x $62.50/hr = $ -- x $ .09 = $__ $__ $__ $~'[ [. 0 0 $ $__