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FOR Crl~ USE ONLY <br />l~eeeived 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 />Cross Street/Directions: <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. CONTRACFOR INFORMATION <br /> <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 sale before or upon completion, lf l <br />hire subconO'actors, I will hire only subcontractors registered with <br />the Construcllon Contractors Board. If l change my mind and do <br />hire a general contractor who is registered with the Construction <br />Contractors Boart~ I wilt immediately notify Marion County of tbe <br />name of the contractor <br /> <br />Owner's Signature: <br /> <br />3. PLAN REVIEW SECTION <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 applicatiom <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 pe~ permit allowed <br />A. Residential Per Unit Service Included: <br /> Items Cost (~a~h) Sum <br />1000 sq. fl. or less -- x $110.00 = $ 4 <br /> <br />Each Manufactured Home or ~...~ ~ <br /> <br /> OnegfwopemllyDwelngFe~:Sq, Feet __ x $ .09=$__ <br /> TOTAL $ __ <br /> <br />5. FEES Al. Enter total of fees from Sec. g4 <br /> <br /> A2. Add State Surcharge (.05% x A1 <br /> <br />SUBTOTAL <br /> <br />B. Enter 30% of line A1 for Plan Review <br />C, Investigation Fee (if requlred) <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. Induslgal Plant ($62.50/hr) <br /> <br />TOTAL AMOUNT DUE <br /> <br />$__ <br />$__ <br />$__ <br /> <br /> <br />