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FOI~ L~E ONLY <br />Received By: Date: <br />Zoning By: City: <br />Receipt #: Amount: $. <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, 1 through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br /> Parce! ID: <br /> <br /> City: Zip: <br /> <br />Cross SueedDin~ions: <br /> <br />P~ITS ARE NON. TRANSFERABlE AND EXPIRE IF WORX <br /> <br />IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br />WORX I$ SUSPENDED FOR 180 DAY~. <br /> <br />2A. CONTRACTOR INFORMATION <br /> <br />Propezty Owner:. (please print) <br />M~lnig 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 he my own general contractor 1 <br />understand that I must register as a conztructian contractor ~f the <br />structure is told or offered for sale before or upon completion, lf l <br />hire subcontractors, I will hire only subcontractors registered with <br />the Construction Contractors BoartL If I change my mind and do <br />hire a general contractor who is registered with the Construction <br />Contractors Board, I will immediately notij~ Madon County of the <br />name of the contractor. <br /> <br />3. PLAN REVIEW SECTION <br /> <br /> Marion County docs 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 with this application. <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 />ltc~ C~t (~h) Sum <br /> <br />5. FEES <br /> A 1. Enter wtal of fees from Sec. g4 <br /> <br /> ,A2. Add State 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 />E 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 ($62.50Par) <br /> <br />TOTAL AMOUNT DUE <br /> <br />$ , <br /> <br />$ , <br />$ <br /> <br />MC 15-34 Rev 9/98 <br /> <br /> <br />