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FOR CITY USE ONLY <br />Rec~ivent By: Date: <br />Zoning By: City: <br />Receipt #: Amount: $ <br /> <br />I ELECTRICAL PERMIT APPLICATION <br /> Please complete all Sections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />Parcel ID: <br />Site Address: ~ y ~ C'~ nt~L/'~_ <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 />Con.actor: <br /> <br /> Mailing Address: <br /> <br /> City: State: Zip: <br /> <br /> Phone: <br /> Fax: <br /> Coattactors Board No.: <br /> Contractor License No.: <br /> Supervisor License No.: <br /> <br /> Signature of Supervising Electrician: <br /> <br />2B. FOR OWNER INSTALLATION <br /> <br /> Mailing Address:~/~ ?s <br /> <br />un 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 completion. Ill <br />hire subcontractors, I will hire only subcontractors registered with <br />the Construction Contractors Board. lfl change my mind and do <br />hire a general contractor who is registered with the Construction <br />Contractors Board, I will immediately notify Matqon County of the <br />name of tbe contracto~ <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 ff you complete Section 51t and submit two (2) sets of <br /> plans and specifications with th s applicat on. <br /> <br />MC 15-34 Rev 9/98 <br /> <br /> MARION COUNTY BUILDING INSPECTION <br /> 3150 Lancaster Dr. NE - Suit~ 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 Inspeatlons per pennlt allowed <br />A. Residential Per Unit Service Included: <br /> Items Cost (each) Sum <br /> <br />Each additional 500 sq. ft. 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 />I~. Services or Feeders (Does not include branch Circuits, see seetinn D) <br /> Installation, Alteration or Relocation <br /> 200 amps or less [ x $65.00 = $ 2 <br /> 201amps to 400 amps -- x $80.00=$ 2 <br /> 401 amps to 600 amps __ x $130.00 = $ 2 <br /> 601 amps to 1000 amps -- x $170.00 = $ 2 <br /> Over 1000 amps or volts -- x $390.00 = $ 2 <br /> ec~mnect Only ~ $55.00 = $ 2 <br /> <br /> Onatl~oFamilyl~ellingFee:Sq. Feet -- x $ .09=$__ <br /> <br />5. FEES Al. Enter total 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. Ralnspection 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 ($62.50/hr) <br /> <br />TOTAL AMOUNT DUE <br /> <br /> <br />