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FOR CITY USE ONLY <br />Received By: Date: <br />Zoning By: City: <br />Receipt #: Amount: $ i <br /> <br /> ELEcTRIcAL PERMIT APPLICATION <br /> Please complete all Sections, 1 through S <br /> <br />1. LOCATION OF INSTALLATION <br />Parcel ID: <br /> <br />Site Address: <br /> <br />PERMITS ARE NON. TRANSFERABLE AND EXPIRE IF WORK <br />IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br />WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INFORMATION <br /> <br /> [I 5) o <br /> <br /> SuperVisor License No.: /~to t/ ~ <br /> Signature of Supervising Electrician: <br /> <br /> INs ,Tio, <br /> <br />Property Owner: (p/ease print) <br />Mailing Address: <br />City: State: Zip: <br /> <br />I am the PROPERTY OWNER and own, reside in, or will reside in <br />the completed structure and will be my own general contractor, l <br />understand thet I must register as a construction contractor if the <br />structure is sold or offered for sale before or ~pon completion, lf l <br />hire subcontractors, I will hire only subcontractors registered with <br />the Construction Contractors BoatrL If I change my mind and do <br />hire a general contractor who is registered with the Construction <br />Contractors Board, I will immediately notify Marion County of the <br />name of the contractor <br /> <br /> Owner's Signature: <br /> <br />3. PLAN REVIEW SECTION <br /> <br />Marion County does not require a plan review, We will provid~ plan <br />review service if you complete Section 5B and submit two (2) sets of <br />plans and spec fications w th th s app ication, <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 />FEE SCHEDULE (complete and enter tolal In Al) <br /> <br />lO00sq, ft~orless -- x $110.00=$__ <br /> <br />C. l~m~rar~ Servlee~eeders <br /> <br /> ~ach branch circuit -- x $3.00 = $ <br /> <br /> Omgl~FamlyDva~lingF~.Sq.F~t -- x $ .09=$__ <br /> <br />2 <br /> <br /> 2 <br /> 2 <br />,2 <br /> 2 <br /> 2 <br /> 2 <br /> <br />2 <br />2 <br />2 <br /> <br />2 <br /> <br />FEES <br /> Al. Enter total of fees from Sec, 04 <br /> A2, Add State Sm'charge (~05% x Al) <br /> <br />SUBTOTAL <br /> <br />$2__ <br />$__ <br />$__ <br />$__ <br />$ <br /> <br /> B. Enter 30% of line A1 for Plan Review <br /> C. Investigation Fee (if required) <br /> D. Reiasgection Fee ($50.00) <br /> E. Additional Plan Review ($62.50/hr, <br /> minimum one-half hoar) $ -- <br /> F. Inspection for which no fee is specifically indica~l, <br /> ($62.50/hr, minimum one hour) $ __ <br /> G. Inspection Outside Normal Business Hours, <br /> ($62.50/hr, minimum two hours) $ __ <br />qq "' ~)'~H' Industrial Plant ($62'50/hr'~ OTAL'T AMOUNT DUE $$-~ <br /> <br /> <br />