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] FOR CITY USE ONLY <br />~ Rec6ivod By: .Date: <br />~ Zoning By: City: <br />~ Receipt #: Amount: $ <br /> <br /> ELECTRICAL PERMIT APPLICATION <br /> Please complete all Sections, I through $ <br /> <br />1. LOCATION OF INSTALLATION <br /> <br /> Parcel ID: <br /> <br /> MARION COUNTY BUILDING INSPECTION <br /> 3150 Lancaster Dr. NE - Suit~ C <br />Salem, Oregon 97305 <br />8:00am - 4:30pm 24 HR Inspection Line 3734427 FAX 588-7948 <br /> <br />4.:FEE SCHEDULE (eOmplet, and enter total in Al) <br /> <br /> PERMITS ARE NON- TRANSFERABLE AND EXPIRE IF WOR. K [ <br />ts NOr: Sr~r~o vrrrmN tgo oars Or tssva~vc~ os tF I <br /> <br />2A. ~NT~R INfO'ON <br /> <br /> Ma~ing Add.ss: <br /> <br /> I am t~ PROP~ OWNER and own, msMe in, or will ~side ~ <br /> s~ct~ is soM or offend for sale b~o~ or ~n co~letio~ ~1 <br /> <br /> Contractors Boa~, I will im~d~tely ~t~ Ma~on Co~¢ of t~ <br /> <br />Owner's Signature: <br /> <br />3. PLAN REVIEW SECTION <br /> <br /> Marion County does not require a pla~ review. We will provide plan <br /> review service if you comple~ Section 51] and submit two (2) sets of <br /> plans and specifications with this application. <br /> <br />1000 sq. fl. 0r I~a <br />Each addifio~l 500 sq. fl. o~ portion dm~of -- <br />Limit~l Energy <br />Each Manufacturod Home or <br /> Modular Dwelling Service or F~der <br /> <br />B. Sexvl~s or Feeder$'(Does not hiclnd~ bram. h CImults, ~e s~t~m D) <br /> <br /> $80.00=$__2 <br />$130.00=$ , 2 <br />$i70.(10 = $ 2 <br />$3~0,00 = $ 2 <br />$55.00 = $.~__2 <br /> <br /> $45,0O=$ 2 <br />$55.00 = $ 2 <br />$110.00 = $ 2 <br /> <br />__ x $3.00= $ <br /> <br />__ x $50.00=$ <br />__ x $3.00=$ <br /> <br />Mhrellaneom (Set,ce or Feeder Not lm:tudl~) <br />Each pump or irrigalio, circle ~ x $~5.00 = $ <br /> -- x $55.00--$ 2 <br /> <br />One/T~mFalrdlyD~llingF~e:Sq. Fect __ x $ .09=$__ <br />Dwdling Perndt Labels (For Single Fm~lly DweWmgs Only) N/C <br /> <br />__ x $55.00 <br /> <br />$, FEES Al. Enter total of fees from Sec. g4 <br /> A2. Add state Surcharge (.05% x Al) <br /> <br />SUBTOTAL <br /> <br />B. Enter 30% of'~ine A1 for Plan Review <br />C. Investigation Fee 0f required) <br />D. Reinspecfion Fee ($~0.00) <br />E. Additional Platt Review ($62.50/hr, <br /> minimum one-half hour) <br />F. Inspection for which no fee is specifically indicated, <br /> ($62.50/hr, minimum on~ hour) <br />G. Inspection Out~ide Nomlal Business Hours, <br /> ($62.50/hr, minimum two hours) <br />H./ndus~al Pla~t ($62.50/h0 <br /> <br />TOTAL AMOUNI DUE <br /> <br />$ <br />$ <br />$ <br /> <br />$__ <br />$__ <br /> <br />$ <br />$__ <br /> <br />MC 15-34 Rev 9/98 <br /> <br /> <br />