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Received By: .Da~e: <br />Zoning By: City: <br />Receipt ~. Amount: <br /> <br />I ELECTRICAL PERMIT APPLICATION <br /> Please complete all SeCtions, 1 thrOugh 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br /> Parcol ID: <br /> SlteAdd~s~! 8724 G°lf Club Rd. <br /> <br /> Crt ~ ~ ~. ~, '//~gip 97385 <br /> P~el <br /> <br />Phone: 769-3485 <br /> <br />Cros~ Str~t~Dir~:tlons: Fa~. 22 <br /> <br /> Proj~tDescdption: remodel pro shop <br /> <br />PERMITS ARE NON. TRANSFERABLE AND EXPIEE IF WORK [ <br />IS NOt StARtED W~.iM ISO DAYS Or ISSUANCE OR IF I <br /> won~ ~s sUs~oro ro~ ~*o OA~, I <br />~. CON~C~R INFO~ON <br /> <br /> con~t~3aveken ~leetr~e to. Inc. <br /> Mailing ~ss: p · 0 · BOX 6~ <br /> City: Stayton sram: 0R zi":97383 <br /> ~: 769'7357 <br /> <br /> c~ n~e No.: 24.327C <br /> <br />2B. ~R O~R ~STAL~ON <br /> <br /> ~y ~ ~lease print) <br /> <br /> I ~ t~ PROP~ owNER ~ own, ~sMe in, or wi~ ~side in <br /> t~ ~t~d ~ a~ will be my own generai co~r~to~ l <br /> <br /> st~m~ ~ soM or offe~ for sa~ be~ or ~pon c~letio~ lf l <br /> C~mcto~ Boa~, I will im~diately ~t~ Marion Coun~ of t~ <br /> <br />Owner's Signature: <br /> <br />3. PLAN R~VI~W SECTION <br />I Marion County does not require a plan review. We will provide plan <br />review service if you complete Section 5B and submit two (2) sets of <br /> plans and specifications with this agplication. , <br /> <br />MC 15-34 Rev 9/98 <br /> <br /> MARION COUNTY BUILDING INSPECTION <br /> 3150 Lancaster Dr. NE - Suite C <br /> Salem, Oregon 97305 <br />8:00am - 4:30pm 24 HR Inspection Line 373-4427 FAX 588-7948 <br /> qq-ooo <br /> 4. FEE SCHEDULE (complete and enter totad in AI~ <br /> <br /> Num~ of In$1~tions I~r p~mfit allowed <br /> A~ ReMdent~d Per Unit Servtre Induded: <br /> <br />Items Co~t (each) Sum <br />~ x $110.00=$ 4 <br />x $20100 = $ <br />-- x $30.00=$ I <br /> <br />__ X ~2.0o = $ ., 2 <br /> <br /> B. Service~ or Feeden~ (Do~ not tedade branch Clmulta, ~ s~fion D) <br /> lmtallation, Alteration or Relocation <br /> 200 amps or less x $65.00 = $ 2 <br /> 201 amps to 400 amps x .o.oo_-s 2 I <br /> 401 mops to 600 amps x $130.00 = $ 2 <br /> I <br /> 601 amps to I000 amps x $170.~0 = $ 2' <br /> Over 1000 amps or volts -- x $390.00 = $ <br /> 2 <br /> Reconnect Only x $55.00 = $ 2 I <br />C. Temporary Services/Feeders <br />] Installation, Alterations, Or Relocation <br />200 amps or leas x $45.00 = $ 2 ] <br />201amps to 400 amps -- x $55.00=$__2 <br /> 401 amps to 600 amps -- x $!10.00=$ 2 <br /> <br /> b) The fee for branch ¢ivzu~ wi~ ~~ <br /> purch~ of ,e. ervice of l~ed~r Fee: ~[ <br /> Each additional branch eire~t ~ x $3.00 = $ <br /> <br /> Signal Ciredit(s) or a Limited En~gy <br /> above, per inspection -- x $50.00 = <br /> <br /> OnatrwoFamflyDwd~Zlt~:Sq. Foe~ -- x $ .09=$ <br /> <br /> Dwelling Permit Labols (Tot Single Family l~vellh~s Ouiy) <br /> OTHER, as required by the Building O{~ldui $ <br /> TOTAL <br /> <br />5. FEES Al. Enter total of fees from Sec. <br /> A2. Add State Surcharg~ (.05% x <br /> <br />B. Enter 30% of line Al for Plan Review <br />C. Investigmion Fee (ff required) <br />D. Reinspeefion Fee ($50.00) <br />E. Additional Plan Review ($62.50/hr, <br /> minimum one-lmlf hour) <br />K Inspection for which no fee is specifically indicated, <br /> ($62.501hr, minimum one hour) <br />G. Inspection Outsid~ N0~al Business Hours, <br /> ($62.50/hr, minimum two houes) <br />H. Industrial Plant ($62.50thr) <br /> <br />TOTAL AMOUNT DUE <br /> <br />$__ <br />$__ <br />$__ <br /> <br />$__ <br />$__ <br /> <br /> <br />