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~FOR CITY USE ONLY <br />?~.~?~ived By: Date: <br />I Zoning By: ~ity: <br />~ Receip~ ~. .Amount: $_ <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />IPERMII~ ARE NON.~aI~FERABLE AND EXPIRE IF ~/~P~g <br /> IS NOT 5TAlt~ED WIYI~IN lgO DAYS OF I$~;UANCE OR IF <br /> WOIL~ I$ SUSPENDED FOR 180 DAYf~ <br /> <br />2k. CONTRACrOR INFORMATION <br /> <br />Ptope~ ~ Colea~e print) <br />Ci~y: Stye: Zip: <br /> <br />I ~ the PROPERTY OWNER a~d own, reside i~ or ~ill reside in <br />the completed z~.mcmre and wJlJ b~ my own general contractor 1 <br /> <br />structure i~ ~old or offered for $a!e before or upon completio~ Ill <br /> <br />Owner's Sigaatme: <br /> <br />~. PLAH REVIEW SECTION <br /> Marion Co~m~y doez n~ ~ a p~ ~v~w. We will ~de p~ ~ <br /> mv~w ~ ifyo0 ~1~ S~fion 5B ~ sub~t t~ (2) ~ ~/ <br /> pl~ ~d ~ifications ~ ~s ~pli~ J <br /> <br /> MARION COUNTY BUILDING INSPECTION <br /> 3150 Lancaster Dr. NE - Suite C <br />Salem. Oregon 97305 <br />8:00am - 4:30pm 24 HR Inspectio~n Line 373-4427 FAX 588-7948 <br /> <br /> 4. FEE ~CHEDULE (comple~ L~-n r~tot~l~'A l ) <br /> <br /> Numb~ of Inspectioos per po'mit allowed <br />A. Resldmflal Per Unit Servi~ lnduded: <br /> <br /> Items Co~ (each) Sum <br />Each additlom1500 sq. ft. or po~ioe thereof x $20.00 = $ <br /> <br />$.50.00 = $ <br />$3.00=$. <br /> <br />S55.00 =$--2 <br />$55.00 = $ 2 <br /> <br />x SI00.00 = $ <br /> <br />x $ .09=$ <br /> <br /> $ <br /> <br /> $ <br /> <br />5. FEES Al. Enter total of fees fa'om Sec. i~ <br /> A2, Add State Smcharge (.05~ x Al) <br /> <br />B. Falter 30% of line A1 for Plan Review <br />C, Investigation Fee (if roquil~l) <br />D. R~nspecfion 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. Insp~ion 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 />