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FOR CITY USE ONLY <br />Received By: ~_~l)ate: <br />Zoning By: ~ity: <br />Receipt #: __ Amount: <br /> <br /> ELECTRICAL PERMIT APPLICATION <br /> <br />L LOCATION OF INSTALLATION <br /> <br /> Parcel ID <br /> <br />Site Address: <br />City: <br /> <br />Parcel Owner. <br />Phone: <br /> <br /> PERMITS ARE NON-TRANSFERABLE AND EXPIRE 1F WORK <br /> ts sot srAsrrv wrrnm ~so DAYS OF lSSUANCE OR 1P <br />~PENOED FOR ISO OARS. J <br /> <br /> Superviso[ License No.2 ~ <br /> Signature of Supervising Electrician~ <br /> / <br />2B. FOR OWNER INSTALLATION <br /> <br />Propei~y Owner: (please pdnt) <br /> <br />Mailing Addxess: <br /> <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. I <br />understand that I must register as a construction contractor if the <br />structure is soM or offered for sale before or ~pon completion. If[ <br />hire subcontractors~ I will hire only rubcontractors registered with <br />the Construction Conox~ctors Boar& If l 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 />Ow~. r's Signature: <br /> <br />3. PLAN REVIEW SECTION <br /> <br /> Marion County dees not require a plan review. We will provide plan <br /> review service if you complete Section gB and submit two (2) sets of <br /> plans and specifications v.4th this application. <br /> <br />MC 15-34 Rev 9/98 <br /> <br /> MARION COUNTY BUII~ING INSPECTION <br /> 3150 Lancaster Dr. ~ - 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 (camplete~and eater total in Al) <br /> <br />1000 sq. ft. or less <br />Each additional 500 sq. ft. or portion thereof <br />Limited Energy <br />Each Manufactured I-I~ or <br /> Modular Dwelling Set. ice or Feeder <br /> <br />Items Cost (each) Sum <br /> x $20.00 = $ <br /> <br />x $52.00 = $ 2 <br /> <br />$65.00 = S <br />$80.00 = $ <br />$130.00 = $, <br />$170.00 = $ <br />$390.~0 = $ <br />$55.00=$ . <br /> <br />x $55.00 = $ 2 <br />x $~.~0 = S 2 <br /> <br />x $55.~0=$ , 2 <br /> <br /> $50.00 <br /> <br />$100.00 <br /> <br /> N/C <br /> <br />$ <br />$ <br /> <br />$ <br /> <br />$ <br />$ <br />$ <br /> <br />5. FEES <br /> A 1. Enter total of fees from Sec./+4 <br /> A2. Add State Surcharge (.05% x Al) <br /> <br />SUBTOTAL <br /> <br />B. Enter 30% of llne A1 for Plan Review <br />C. Investigation Fe~ (if required) <br />D. Reinspeetion Fee ~$50.00) <br />E. Additional Plan Review ($62.50/hr, <br />minimum one-half hour) $ <br />F. Inspection for which no fee is specifically indicated, <br />l$62.50/hr, minimum one hour) $ __ <br />G. Inspection Outside Normal Business Hours. <br />($62.50/hr. minimum two hours) $ __ <br />H. Indus~al Plant ($62.50/hr) $ __ <br /> <br />TOTAL AMOUNT DUE $ <br /> <br /> <br />