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FOR CItY USE ONLY <br />i',Receive~t By: Date: <br />Zoning By: .City: <br />i Receipt #: Amount: <br /> <br />ELECTRICAL pERMIT APPLICATION I <br />Please complete all Sections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br />Parcel ID: <br />Site Address: <br />City: Zip: <br />Parcel Owne~: <br />Phone: <br />Cross Street/Directions: <br /> <br /> Project Description: <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 /> su i,or License No.: <br /> Signatare of Supervlsing ~iec~%ian:lJ <br /> <br />2B. FOR OWNER INSTALLATION <br /> <br />Property Owner: (please prinO <br /> <br />Mailing Add.ss: <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 upon comple~ion, lf l <br />hbe subcontractors, 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, l will immediately noti~ Marion County of tbe <br />name of the contractor. <br /> <br /> Owner's Signature: <br /> <br />3. PLAN REVIEW SECTION <br /> <br />Marion County does not require a pian review. We will provide plan [ <br />review service if you complete Section 5B and submit two (2) sets of <br />p aris and spec ficat OhS w th this appl cation. <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 total in Al) <br /> <br /> Number of Inspections per perafit allowed -- <br />A~ Residential Per Unit Service Included: <br />Items Cost (each) Sum <br />1000sq. ft. orless -- x $110.00=$__4 <br />Each additional 500 sq. 1~. or portion thereof -- x $20.00 = $ -- <br />Limited Energy -- x $30.00 = $ -- 1 <br />Each Manufactured Home or <br />Modular Dwelling Service or Feeder -- x $52.00 = $ -- 2 <br />B. Services or Feeders (Do~s not include branch Circuits, see section D) <br /> Installation, Alteration or Relocation <br /> 200 amps or less ] x $65.00 = $ __ 2 <br /> 20i amps to 40O amps -- x $80.00=$__2 <br /> 401 amps to 600 amps -- x $130.00=$__2 <br /> 601 ampsto 1000amps -- x $[70.00 =$__2 <br /> Over 1000 amps or volts -- x $390.00 = $ -- 2 <br /> Reconnect Only __ x $55.00=$__2 <br /> <br />5. FEES Al. Enter total of fees from Sec. g4 <br /> <br /> A2. Add St~ Surcharge (.05% x Al) <br /> <br />SUBTOTAL <br /> <br />B. Enter 30% of line Al for Plan Review <br />C. Investigation Fee (if required) <br />D. Reinspection 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 /> ($62.50/hr, minimum one hour) <br />G. Inspection Outside Normal Business Hours. <br /> ($62.50/hr, minimum two hours) <br />H. Industrial Plant ($62.50/hr) <br /> <br />TOTAL AMOUNT DUE <br /> <br />MC 15-34 Rev 9/98 <br /> <br /> <br />