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~ZOeccR CPI'Y USE ONLY <br /> ivcd By: Date: <br /> <br /> Zoning By: .City: <br /> Receipt g:. Amount: $ <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through $ <br /> <br />1. LOCATION OF INSTALLATION <br />Parcel ID: <br /> <br />]~oject I~s~iption: ~,~ ~ ~ <br /> <br />[PERMIYS ARE NON. TRANSFERABLE AND EXPIRE IF WORK I <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 />Mailing Address: <br />City: Stat~: Zip: <br /> <br />I am the PROPERTY OWNER and own, reside in, or will reside in <br />the completed structure and will he my own general contractor, l <br />understand that I mu~t register a~ a construction contractor if the <br />structure is sold or offered for sale before or upon completion, lf l <br />hire subcontractors, I will hire only subcontractors registered with <br />the Construction Contractors Bonn~ If I change my mind and do <br />hire a general contractor who is registered with the Construction <br />Contractors Boan~ 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 />plans and specifications w ~h this apl) leal/on. <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-,~4, 27FAX 58g~7948 <br /> <br /> FEE SCHEDULE (complete and enter ~ in Al) (~ ' <br /> <br /> Number of Inspections per permit allowed -- <br />A. ReMdeat~l Per Unit Service Included: <br /> Items Co~t (each) Sum <br />1000sq. ft. orl~ss -- x $110.00=$__4 <br />Each additional 500 sq. ft. or portion ~hcr~of -- x $20.00 = $__ <br />Linfited Energy -- x $30.00 = $ -- 1 <br /> <br /> 200 amps or less <br /> <br /> Each pump or hrigation circle -- x $55.00 = $.~_~"2 I <br /> <br /> Omll'woFamllyDvndlnigFee:Sq. Feet -- x $ .09=$__ <br /> OTHER, as reqni~l by the Building Omcial <br /> <br />$. FEES Al. Enter total of fees fxom Sec. 04 <br /> A2. Add State Surehasge (.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. 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 /> ($62.50/hr, minimum one hour) <br />G. Inspection Outside Normal Business Hours, <br /> ($62,50/hr, minimum two hours) <br />H. Indes/a-lal Plant ($62.50/hr) <br /> <br />TOTAL AMOUNT DUE <br /> <br />$__ <br />$__ <br />$__ <br />$__ <br /> <br />$__ <br />$__ <br /> <br />$__ <br />$__ <br /> <br />MC 15-34 R~v 9/98 <br /> <br /> <br />