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FOR ~ITY~ USE ONLY <br />· ~ ~ec~ei~v~d By: Date: <br />: ~Zonin8 By: City: <br />~ Receipt ~. __ Amount: <br /> <br />ELECTRICAL PERMIT APPLICATION <br /> <br /> Please complete all Sections, 1 through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br /> Parcel Owner. ~ <br /> <br /> PERMITS ARE NON. TRANSFERABLE AND EXPIRE IF WORK ] <br /> IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br />I <br />~FOR I8O DAYS. _.~ <br /> <br />2A. CONTRACTOR INFORMATION <br /> <br />Mailing Address: <br />City: State: Zip: <br />Phone <br />Fax: <br />Conlractors Board No.: <br /> <br />Supervisor License No.: <br /> <br /> Signature of Supervising Electrician: <br /> <br />2B. FOR OWNER INSTALLATION <br /> <br /> Property Owner: (please pdnt) ~'~ ~"lt' l ~ ~t~t'¢~d~ <br /> Mailing Address: ~ <br /> City: State,' ~. Zip: 7t~ <br /> I am the PROPERTY OWNER and own, reside in. or will reside in <br /> the completed structure and wile 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 before or vpon completion. If l <br /> hire subcontractors, I will hire only subcontractors registered with <br /> the Construction Contractors Board.~J~ I change~.l~y mind and~o <br /> hire a general contractor who is ~tered.~t ~e ConStruction <br /> Contractors Boan~ I will imme~ly n~fj ~rio~unty/a~ the <br /> name of the contractor. , // / J /' J <br /> <br />3. PLAN REVIEW SECTION <br /> <br />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 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-~427 FAX 588-7948 <br /> <br />4. FEE SCHEDULE (eomlflete and enter tots1 in Al) <br /> <br /> Number of lnsi~ctions per pemfit allowed <br /> A. R~ldenflal Per Unit S~rvl~e Ineluded: <br /> <br />5. FEES Al, Enter total of fees from Sec. g4 <br /> <br /> A2, Add State Surcharge (.05% x Al) <br /> <br />SUBTOTAL <br /> <br />B. Enter 30% of line A1 for Plum Review <br />C. Investigation Fee (if required) <br />D. Reinspection Fee ($50.00) <br />E. Additional Plan Review ($62.50gar, <br /> minimum one-half hour) <br />F. Inspection for which no fee is specifically indited, <br /> ($62.50gar, 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 /> <br />