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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, I through 5 <br /> <br />I. LOCATION OF INSTALLATION <br /> <br /> Parcel ID: <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 />Contractor: <br /> <br />Mailing Address: <br /> <br />Phone: <br /> <br />Contractor License No.: <br /> <br />Supervisor License No.: <br /> <br />Signature of Supervising Electrician: <br /> <br />2B. FOR OWNER INSTALLATION <br /> <br /> Property Owner: (please <br /> <br /> M~Jllng Address: <br /> <br /> State~ Zip: <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 sMe before or upon completion, 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 Co~truction <br /> Contractors Board, 1 will immediately notify Ma~on County of the <br /> name of the contractor <br /> <br />3. PLAN REVIEW~CTIO~N <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 SCHEDULE (complete and enter total in Al) <br /> <br /> Number of Inspections per !~ntht allowed <br />A. Residential Per Unit Service Included: <br /> <br />10130 sq. fl. or less <br />Each additional 500 sq. ft. or portion thereof -- <br />Limited Enexgy <br />Each Manufactured Home or <br /> Modular Dwelling Service or F~eder <br /> <br /> Items Cost (each) gum <br />-- x $110.00=$ 4 <br /> x $20.00=$__ <br />-- x $30.00=$ 1 <br /> <br />__ x $52.00=$ 2 <br /> <br />B. Services or Feeders (Do~s not include branch Circuits, see section D) <br /> Installation, Alteration or Relocation <br /> 200 ~mps or less -- x $65.00 = $ -- 2 <br /> 201araps to 400 amps -- x $80.00=$__2 <br /> 401 amps to 600 amps __ x $130.00=$__2 <br /> <br /> Onet'~oFamilyDwelllngFee:Sq.F~t -- x $ .09=$__ <br /> TOTAL $ ~ 0 <br /> <br />~x $3.00 <br /> <br />$50.00-- $ <br /> $3.00 =$ <br /> <br /> 2 <br /> 2 <br /> <br />5. FEES Al. Enter total of fees from See. g4 <br /> <br /> A2. Add State Surcharge (.05% x Al) <br /> <br />B. Enter 30% of line A1 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 />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 ($62.50/hr) <br /> <br />TOTAL AMOUNT DUE <br /> <br />SUBTOTAL $ ~,~ <br /> <br /> <br />