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FOR cl*rv USgONLY <br />R~ceived By: .Date: <br />Zoning By: City: <br />Receipt #: ,, Amount: $ <br /> <br />ELEC"FRICAL PERMIT APPLICATION <br />Please complete all Sections, 1 through $ <br /> <br />1. LOCATION OF INSTALLATION <br />Parcel ID: <br />Site Address: <br /> zip: <br /> ,.one: 'F q- q oot <br />Cross Street/Directions: <br /> <br />[ IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br />WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />Mailing Address: <br />City: State: Zip: <br /> <br />I am the PROPERTY OWNER and own, reside in, or will t~side in <br /> <br />Contractors Board, I will immediately notiJ~ Matron County of the <br /> <br />Own~'s Signature: <br /> <br />3. PLAN REVIEW SECTION <br /> <br /> Marion County do~s not l~lnim a plan review. We will provide plan <br /> review service if you compile Section 5B and submit two (2) se~s of <br /> plans and specifications with this application. <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 /> <br />4. FEE SCHEDULE (esmplet~ and ~nt~r total in Al) <br /> <br /> Number of lnsl~cfions per permit allowed <br /> A. Reddenflal Per Urdt Service Included: <br /> <br />1000 ~, ft. or less <br />Each additional 500 scI. fi. o~ peRion thereof <br />Limited Energy <br />Each Manufactured Home ~ <br /> Modular Dwelling Service or Feeder <br /> <br /> Items Cost (e~ch) Sum <br /> x $110.00 = $__4 <br />x $20.00=$__ <br />__ x $30.00=$__1 <br /> <br />$52.00=$__2 <br /> <br />B. Services or Feeders (D~s not Include branch Circuits, see s~Alon D) <br /> <br />Do <br /> <br />Installation, Alteration or Relocation <br />201 amps to 400 amps <br /> <br />Onefl~eo Family DwallJng Fee: Sq. Feet <br /> <br />Dwell~nB Permit Labels ~or ~ Family ~elli~zs <br /> <br />OTHER, as required by the Building Official <br /> <br />-- x $~0.~0=$__2 <br />-- x $130.00 = $ 2 <br />x $170.00=$__2 <br />x $390.00=$__2 <br />-- x $55.00=$__2 <br /> <br /> $45.00=$ 2 <br />$55.00 = $ 2 <br />$110.00 = $ 2 <br /> <br />__ x $3.0o=$ F2''' <br /> <br />-- x $50.00=$__ <br />-- x $3.00 = $__ <br /> <br />-- x $55.00=$__2 <br />-- x $55.00=$__2 <br /> <br />-- x $55.00=$ 2 <br /> <br />-- x $50.00=$__ <br /> <br />-- x $100.00=$__ <br /> <br />-- x $62.50&r = $__ <br /> x $ ,09 =$__ <br /> <br />5. FEES Al. Enter total of fe~a from Sec. ~4 <br /> A2. Add Stal~ Su~harga (.05% x Al <br /> <br />SUBTOTAL <br /> <br />B. Enter 30% of line A1 for Plan Review <br />C. Investigation Fee (if required) <br />D. R(mspection Fee ($50.00) <br />E. Additional Plan Review ($62.50/hr, <br /> minimum one-half hour) <br />E Inspection fur which no fee is specifically indicated. <br /> ($62.50/hr, minimum one hour) <br />G. Inspection Out~ide Normal Business Hours, <br /> ($62.50/hr, minimum two hours) <br />H. Industrial Plant ($62.50/hr) <br /> <br />TOTAL AMOUNT DUE <br /> <br />$__ <br />$__ <br />$__ <br /> <br /> <br />