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FOR CITY USE 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 />Parcel ID: <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORE <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 /> Contractor: <br /> <br /> Mailing Address: <br /> <br /> City: State: Zip: <br /> <br /> Phone: <br /> Fax: <br /> Contractors Board No.: <br /> Contractor License No.: <br /> Supervisor License No.: <br /> <br /> Signature of Supervising Electrician: <br /> <br />2B. FOR OWNER INSTALLATION <br /> <br />I ] dtbe P~o~ 0~ and ow~ msMe in, or will ~side in I <br /> <br />the completed structure and will be my own general contractor. 1 <br />understand that I must register as a construction contractor if tbe <br />structure is soM or offered for sale before or upon completiot~ lf l <br />hire subcontractors, I will hire only subcontractors registered with <br />the Construction Contractors Board. If I 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 tbe contracton <br /> <br /> Marion County does not require a plan review, We will provide plan I <br /> review service if you complete Section 5B and submit two (2) sets of <br /> plans and specifications with this app cation. <br /> <br />MC 15-34 Rev 9/98 <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 SCI~DULE (complete and enter total in Al) <br /> <br /> Number of Inspections per permit allowed <br />A. Residential Per Unit Service Included: <br /> Items Cost (each) Sum <br />l(]00sq, ft. orless __ x $110.00=$ 4 <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 />Medular Dwe~a~g~vice or Feeder x $52.00 = $ .2 <br />B. Services o ~de~_~ not include branch Circuits, see section D) <br /> lnstaflatlon,~l'~ation or Relocation <br /> 200 amps or less [ x $65.00=$__2 <br /> 201 amps 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 /> Reconnect Only -- x $55.00 = $ __ 2 <br /> <br /> Each edditional branch circuit 15 x~$3.00 = $ ~-. ~'~ <br /> <br />5. FEES <br /> Al. Enter total of fees from Sec. g4 $ <br /> A2. Add State Surcharge (,I~% x Al) $ __ <br /> 70 SUBTOTAL $ __ <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 ($62.50fn~, <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 Nonual Business Hours, <br /> ($62.50/hr, minimum two hours) <br /> H. Industrial Plant ($62.50/hr) <br /> <br />TOTAL AMOUNT DUE <br /> <br />$ <br />$ <br /> <br /> <br />