Laserfiche WebLink
FOR CITY USE ONLY <br />R/~iv~0YBy." Date: <br />Zoning By: .City: <br />Receipt #: Amount: $. <br /> <br />I ELECTRICAL PERMIT APPLICATION <br /> Please complete all Sections, 1 through $ <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />Parcel ~ner~ ~ <br /> <br />Cross Street/Directions: <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 />IContractor: ,~-~--------~Ot.~ ~ <br /> Mailing Address: ~q~,~ I~,~.t.n~.- ~ <br /> <br />City: ~~ State: ~ Zip: <br />Vho.e:a ?Z?-/ffoo - 6 gg <br />Fax: <br /> <br />Con~.~o. Bo~aSo.: ~ 3t"5 7 gE <br />Contractor License No.: c~O -- ~:>O <br /> <br /> Supervisor License No.: ~}Sgt~ -- S <br /> S gnature of Superv sing E ectrician: <br /> <br />2B. FOR OWNER INSTALLATION <br /> <br />Propeay Owner: (please print) <br />Mailing Address: <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 sold or offered for sale before or upon completiora lf l <br />hire subcontractors, I will hire only subcontractors registered with <br />the Construction Contractors Board. lf 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 /> Owner's Signature: <br /> <br />3. PLAN REVIEW SECTION <br /> <br />Marion County does not require a plan review. We will provide plan <br />review service if you complete Section 5B and submit two (2) sets of <br />p aris and speeificlnions with this application. <br /> <br />MC 15-34 Rev 9198 <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 3734427 FAX 588-7948 <br /> 4. FEE SCHEDULE (complete and enter total in Al)qt~'~o'~q{~5' <br /> <br /> Number of Inspections per permit allowed <br />A, Residential Per Unit Service Included: <br /> <br /> Items Cost (each) Sum <br /> 1000 sq. 1~. or less __ x $110.00 = $ -- 4 <br />Each additional 500 sq. fl. or portion thereof -- x $20.00 = $__ <br />Limited Energy -- x $30.00 = $ __ 1 <br />Each Manufactured Home of <br /> Modular Dwelli Sr~e~l~__or ~ t ~ x $52.00 = $__2 <br />B. Services or Feeders (Do~ not include branch Circuits, see section D) <br /> Installation, Alteration or Relocation <br /> 200 amps or less [ x $65.00 = $ -- 2 <br /> 201 amps to 400 amps -- x $80.00 = $ 2 <br /> 401 amp~ to 600 amps -- x $130.00=$__2 <br /> 601 ampsto 1000amps -- x $170.00--$__2 <br /> Over 1000 amps or volts -- x $390.00 = $ -- 2 <br /> <br />5. FEES <br />Al. Enter total of fees from Sec. g4 <br />A2. Add State Surcharge (.05% x Al) <br /> SUBTOTAL <br />B. Enter 30% of line A1 for Plan Review <br />C. Investigation Fee (if required) <br />D. Reinspection Fee ($SO.O0) <br />E. Additional Plan Review ($62.50/hr, /' <br />minimum one-half hour) [ i~'~ <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 ($62.50gar) <br /> <br />TOTAL AMOUNT DUE $ <br /> <br /> <br />