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..................................... c~ MARION COUNTY BUILDING INSPECTION <br />F~OR CITY USE ONLY /~}~ ~,~, I~ 3150 Lancaster Dr. NE - Suite C <br /> · ~ - l~/~e~.~-~-'~ ~/~ Salem, Oregon 97305 <br /> Received By: ~,a~: <br /> <br />.............................. <br /> L CXmCAI RMrr APPLICAtIOn! <br /> <br />I.~CATIONOF~STALLA~ON ~a~eff/~ ~ha~ition~5~.fL~ffi~f ' $~.~=$ <br />P~I~' /~ ,Li~e~ ~ $~.~= <br /> E~h M~uf~ <br /> <br />PERMITS A~E NOfq. TRANSFERABLEAND EXPIRE IF WORR <br />IS NOT SrA~T~D wrrHlle lSD DAYS OF ISSUANCE OR IF <br /> WORK,i$ SH~PgNDED FoR tSO DA~S~ . <br /> <br />lA. CONTRACTOR INFORMATION <br />Contractor, <br /> <br /> Mailing Address: <br /> <br />City: Slate: Zip: <br />Phone: <br />Fax: <br /> <br />Co~tra..ctor License No.: <br />Supe~,isor License No.: <br /> <br /> Signature of Supervising Electrician: <br /> <br />2B. FOR OV~rNER INSTALLATION <br /> <br />PropenyOwner:(ple~ept~nt) ~l~v~ <br /> <br />c ty: oP--- zip: <br /> <br /> I am the PROPERTY OWNER and own, reside in, or will reside in <br /> the completed structure and will be my own general c6ntractor I <br /> understand that lmust register as a construction contractor if the <br /> strucnev is sold or offered for sale before or ~pon completiott If 1 <br /> hire subcontractors, I will hire only subcontractors registered with <br /> the Construction Contractors Boar& If l change my mind and do <br /> hire a general contractor who is registered with the Construction <br /> Contractors Board. I will immediately noti~ Marion County of the <br /> name of the conrracIo~ <br /> <br />3. PLAN REVIEW SECTION <br />IMarion County doe~ not reqmre a plan review. We will provide plan <br />review service if you complete Section 5B and submit two (2) sata of <br />plans and specifications with this application. <br /> <br />Modular Dwelling Servi~e or Feedea' x $52.~0 = $ __ 2 <br />200 amps or less x $65.00 = $ ~ 2 <br /> <br /> 601 ampa to 1000 amps x $170:00 -- $ { <br /> <br /> New, Alteraflm~ or ,Exte~o~ Pm' ~ <br /> <br /> ourehase of Service or Feeder Fee: ,e~ {~ ~d~,,/ <br /> <br /> First branch circuit x'~$50:~-- $ <br /> <br />5. FEES Al. Enter total of fees from Sec. ~ <br /> A2. Add Stat~ Surchmge (,05% x Al) <br /> <br />SUBTOTAL <br /> <br />B. Enter 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 />E 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. IndusMal Plant ($62.50/hr) <br /> <br />TOTAL AMOUNT DUE <br /> <br />$ <br />$ <br />$ <br /> <br />MC 15-34 Rev 9/98 <br /> <br /> <br />