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..................................... MARION COUNTY BUILDING INSPECTION <br />iF OR CITY USE ONLY 3150 Lancaster Dr. NE - Suite C <br />~ Received By: .Da~: Salem, Oregon 97305 <br />~ Zoning By: ~2ity: 8:00am - 4:30pm 24 HR ~nspnetion Line 373-4427 FAX 588-7948 <br />~ Receipt ~ Amount: $ ~ :~ ' ~ ' ' <br /> <br />...................................... <br /> <br />I ELECTRICAL PERMIT APPLICATION <br /> <br />L LOCATION OF INSTALLATION <br /> <br />2.4.. CONTRACTOR ~ ~I~ORMATION __ <br /> <br /> Fax: <br /> <br /> Contractor License No.: ~ ~.~ 3 ~ ~' <br /> <br />2B. FOR OWNER ~AL~ON ~ <br /> <br />Address: <br /> <br />City: Stale: 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 contractog 1 <br />understand that l must register a~ a construction contractor if the <br />structure is sold or offered for sale before or upon completion. Ill <br />hire suheontractor~, I will hire omy subcontractors registered with <br />the Construction Contractors Boan~ If I change my mind and do <br />hire a general contractor who is registered v~'th t~e Construction <br />Contractors Board. I wilt imo~diately notify Marion County of the <br />name of the ~ontractor <br /> <br />Omner's Signature: <br /> <br />L PLAN REVIEW SECTION <br /> <br />Marion County does not r~quire a pla~ r*vi*w. Wg will provide'plan <br />review service ff you complete Section 5B and submit two (2) sets of <br />plans and specifications with this application. <br /> <br />MC 15-34 R~v 9/98 <br /> <br /> Number of inspections l~.r per~t allowed <br /> <br /> Sam <br />1000sq. ft, orl~ss . , x $110,00=$ 4 <br />Each additional 500 sq. ft. or portion the~of x $20.00 = $ <br />Limited Fmergy ' x $30.00 = $ 1 <br />Each ManufactuL~d Ho~ cc <br /> Modular DWe ng Serv ce o~ Fei~r x $52.00 -- $ 2 <br />Bi Sern4c~ o~ ~eeders (Do~ ~tot' ~clod~ branch Circuits, ~ section D) ' <br /> InstaJlation, Alteration or Relocation <br /> 200 amps oF less x $65.00 = $ 2 <br /> <br /> InStallatiOn, Altet~tl~u, ~F Relocaflo~t <br /> <br /> 5. FEES <br /> <br /> A2. Add State SUrehaege (.05% x Al) <br /> <br />SUBTOTAL <br /> <br />$. <br />$ <br />$ <br /> <br />B. Enter 30% of line Al for Plan Review <br />C. Investigation Fee (if requL,~d) <br />D. Rcinspecfion Fe~ ($50.00) <br />E. Additional Plan Review ($62.50/hr. <br />minimum one-half hour) $ <br />E Inspection for which no fee is specifically indicated. <br />($62.50/hr, minimum one hour) $ <br />G. Inspection Outside Nonoul Business Hours, <br />($62.50/hr, minimum two hours) $ <br />H. Indugrial Plant ($62.50/hr) $ <br /> <br /> TOTAL AMOUNT DUE $ <br /> <br /> <br />