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i Receipt #: ~t~- ~'~ <br /> <br />I ELECTRICAL PERMIT APPLICATION <br /> Please complete all Sections, 1 through $ <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />Parcel ID: <br /> <br />Cross Street/Directions: <br /> <br /> MARION COUNTY BUILDING INSPECTION <br /> 3150 Lancaster Dr. NE - Suite C <br /> ~__~[~ Salem. Oregon 97305 <br /> a - 4:30pm 24 HR Inspec6on Line 373-4427 <br /> <br /> %'/6{~'~ 1 3 ~ESCHEDULE(eon~eteandenterto~alinA1) <br />I Number o f Inspections i~r pcnnil <br /> ~ARION ~ ~.lRestdenttal Per Vnlt Se~tc~ Included: <br /> !GIION cos,(c <br /> BUILDING IN$ orlcss __ x $ltO.OO=$ 4 <br /> F~achadditiona]5OOsq. ft. orponionthoreof -- x $20.00=$__ <br /> <br /> Each M~mufactu~d Home or <br /> MedularDwel~ngSowic~orFeed~ -- x $~2.00--$__2 <br /> B. Services or Feeder~ (Do~ ~ot include braac~ Circnik% ~e section D) <br /> I~tallaflon, Alteration or Relocaflo~ <br /> 200 amp~ or l~ss __ x $6~.00 = $__ 2 <br /> 201amp~w400aml~ -- x $80.00--$__2 <br /> 401 amps to 600 arnI~ -- x $130.00--$__2 <br /> 601arnps to l000 amps -- x $170.00--$__2 <br /> Over 1000 amps or volts -- x $3~0.00 = $__ 2 <br /> <br /> Om~l~m~F~nn~l~F~..Sq. Feet __ x $ ,09=$__ <br /> OTHE~ as reqmlred by the Building Official <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK I <br />IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br />WORE IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACI'OR INFORMATION <br />Contr~ctoc <br /> <br />Mailing Address: <br /> <br />City: <br /> <br />Conwacwrs Board No.: <br /> <br /> ~on~ractor Licenae No.: <br /> <br />Supervisor License No.: <br /> <br />Signature of Supervising I~ecttician: <br /> <br />2B. FOR OWNER INSTALLATION <br /> <br /> MailingAddres~:~O~[~ 5l~' /~1~ ~ I <br /> <br /> I am the PROPER~OWNER ami own, reside in, or will reside 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 befon~ 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 contractor who is registered with the Construction <br /> Contractors Board. I will immediately noti~at~on County of the <br /> nameofthecontractor~ ~ <br />3. PLAN REVIEW SECTION ~' <br /> <br />Marion County does not require a plan review. We will pwvidc plan <br />review service if you complete Section 5B and submit two (2) sets of <br />p aris and specifications wioh th~ application. <br /> <br />FEES <br /> Al. Enter total of fees from Sec. 84 <br /> A2. Add State Surcharge (.05% x Al) <br /> <br />SUBTOTAL <br /> <br />B. Enter 30% of llne A1 for Plan Review <br />C. Investigation Fee (if required) <br />D. Reinspnetion 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 iddicatex~ <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 ($62.50/hr) <br /> <br />TOTAL AMOUNT DUE <br /> <br />MC 15-34 Rev 9/98 <br /> <br /> <br />