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FOR CITY USE ONLY <br /> Received By: Date: <br /> Zoning By: City: <br /> <br /> ................................ 'v-- ; :;. , .4;l~,_,E~FiEDULE(~Omple{eaml~4~tertotallaA1) <br />~CAL PERMIT APPLICATION'--] : Nui~r of l~c~o,~ p~ penait al0w~l -- <br /> Please complete-all SeCtions, 1 through 5 I' L ~ A, g~dential Per Oatt Ser~lee l~einde~: · <br /> · ~ : ii ~ ' Items Coat (e~) Sum <br /> 1000 sq. ft. or less x $110.00=$ 4 <br />I. LOCATION OF INSTALLATION ~ach additional 5® ~. ft, ca-Portion theXC°f x $20.00 = $ <br /> <br />ci/y~ zip: ' ' <br /> <br />Pared Owner: ~,LOPIi(J~ A]~ ~ ~_ <br />~on¢: <br /> <br /> PERMITS ARE N~ON. TRANSFERABLE AND EXPIRE IF WORK I <br /> IS NOT ST/~RTED WITHIN 180 DAYS OF ISSUANCE OR IF I <br /> WORK IS susPENDED FOR 180 DAYS. ' <br /> <br />~,A. CONTRACTOR INFORMATION <br /> <br />Mailing Address: PO g0.-~, 1,..~(O~"'~ <br />City: ~h~.~,,.~ State:~-~ Zip: <br /> <br /> Signature of Supervising Elec~ <br /> <br />2B. FOR OWNER INSTALLATION <br />PropeflyOwner:. (please <br /> print). <br /> <br />[ l.amthe P. RO. PERTY OWN~R.~d own reside in, or will reside in <br />the completed structure and will be my own general contractor 1 <br /> <br />structure is sold or offered for sale before or ~pon completiom Ill <br />hire subcontractors. I will hire only subcontractors registered with <br />the Construction Conlractors Boant. [f I change m) mind and do <br />hire a general contractor who is regtstered with the Constrtiction <br />Contractors Board. I will immediately notify Marion County of the <br /> <br />3. PLAN REVIEW SECTION <br /> <br /> Marion County does not reqwre 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 application· .~ <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 />5. FEES Al. Enter total of fnes fi.om Sec. #4 <br /> A2. Add State Surcharge (.05% x Al) <br /> <br />B. Enter 30% of line A 1 for Plan Review <br />C. Investigation Fee (if required) <br />D. Reinspecfion Fee ($50.00) <br />E. Additional Plan Review ($62.50flar, <br /> mimmum one-half hour) <br />E Inspection for which no fee is specifically indicated, <br /> ($62.50/hr, minimum one hour) <br />G. Inspection Outside NormalBusiness Hours. <br /> ($62.50/hr, mlnim~m two hours) <br />H. Industcial Plant ($62.50/hr) <br /> <br /> TOTAL AMOUNT DUE <br /> <br />SUBTOTAL <br /> <br />$ <br /> <br />MC 15-34 Rev 9/98 <br /> <br />Limit~l Energy x $30.00 = $ <br />Each Manufactured Home c~ <br />' Mo~fl ar DWellin§ ~Se~'i¢, or Feeder x $52.00 -- S <br />B. Servtee~ or Fe~x~ (Do~s nOS inelmle bra~lt Cb~fta, ~ aeetl~ D} <br /> <br /> 200 amps or less I x <br /> 201 amps to 400 amps x $80.0~ = $ <br /> 401 amps to 600 amps x $130.00 = $ <br /> <br /> Over 1000 maps or volts x $390.00 = $ <br /> <br />C.' Temporary Services/Feeders <br /> ~n~on,.Altemtinns, or RelOention <br /> <br /> 201 amps to 400 amps x $55.00 = $ <br /> 401 amps to 600 amps x $110.00 = $ <br /> <br /> Each branch e~rcuit x $3.00 = $ <br /> b) The fee for branch circmis without the <br /> <br /> Each additional branch circuit x $3.00 = $ <br /> <br />Each pump or irrigation circle x $55.00 = $ <br />Each Sign or Outline Lighting x $55.00 -- $ <br />Signal Circuit(s) or a Limited Enexgy <br />paael, Alteration or Extension x $55.00 = $ <br />F. Each additional Inspection <br /> <br />G. M/nor Ins~uilation Labels <br />Pack of 10 labels @$10.00 each x $i~0.~0 = $ <br />(Sold only to Ele~cal Contractors) <br />H. Indnstrial Plant x $62.50/hr = $ <br />Om/Two Family I)wel~g F~: Sq. Fe~ x $ 09=$ <br /> I)weIling Permit Labels ~For Single Family Dwellings Only) <br /> OTHER, aa required by the Building Official $ <br /> <br /> <br />