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Received By: _Date: <br />Zoning By: .City: <br />Receipt ~. Amount: $. <br /> <br /> ELECTRICAL PERMIT APPLICATION <br /> Please complete all Sections, 1 through 5 <br /> <br />I. LOCATION OF INSTALLATION <br /> <br />Parcel ID: <br />Site Address: I Z O' <br />Zip: <br /> <br /> d <br /> o"/f <br /> <br />PERMITS ARE NON. II~ANSFERABLE AND EXPIRE IF WORE <br />IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br />WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTORINFORMATION <br /> <br />Prol~ny Owner: (please prinO <br />Mailing Address: <br />City: State: Zip: <br /> <br />l am the PROPERTY OWNER and own, reside in, or will reside in <br />the completed structure and will be my own general contractor. 1 <br />understand that I must register as a construction contractor if the <br />structure is sold or offered for sale before or upon completia~ If I <br />hire subcontn~ctors, I will hire only subcontractors registered with <br />the Construction Contractors Board. If I change my mind and do <br />hire a general contractor who is registered with the Construction <br />Contractors Board, I will immediately nntij? 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 pmvido 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 373-4427 FAX 588-7948 <br /> <br />4. FEE SCHEDULE (complete and enter to4al in Al) <br /> <br />200 amps or less I x $65.00 = $ ~o~ 2 <br /> <br />~ach pump or inigation cirde / x ~5,oo = $ .?'~' 2 <br /> <br />Oue'l~FamilyB~ll~F~e:Sq. Feet __ x $ .09=$__ <br /> <br /> $120 <br /> <br />5. FEES Al. Enter total of fees from See. ~- <br /> A2. Add Slate Surcharge (.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. Reinspeetion Fee ($50.00) <br />E. Additional Plan Review ($62.50/hr, <br /> minimum one-half hour) <br />R Inspection for which no fee is specifically indicat~l, <br /> ($62.50/hr, minimum one hour) <br />G. Inspection Outside Nonnal Business Hours, <br /> ($62.50/hr, minimum two hours) <br />H. Indas~ial Plant ($62.50/hr) <br /> <br />TOTAL AMOUNT DUE <br /> <br />$1'Zo <br /> <br />$1-z6 <br /> <br /> <br />