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FOR CITY USE ONLY <br />R~eceived BY: <br />Zoning By: City: <br />Receipt #: Amount: $. <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <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 lSO DAYS. <br /> <br />Mailing Address: <br />City: Stu~: Zip: <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 conlractor 1 <br />understand that I mu~t register as a construction contractor if the <br />structure is sold or offered for sale before or upon completion, lf l <br />hire subcontractors, I will hire onJy 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 the comractor. <br /> <br />Ownex's Signature: <br /> <br />3. PLAN REVIEW SECTION <br /> <br />Marion County does <br />review service if you <br />plans and specificatiot <br /> <br />MC 15-34 Rev 9/98 <br /> <br /> NOTICE <br /> EFFECTIVE 7-1-99 <br />STATE SURCHARGE CHANGE <br />FROM 5% TO 7% <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 /> 4. FEE SCHEDULE (complete and anter ,oral in Al?* ' 0 ~'"~S / <br /> <br />1000 sq. ft. or less <br />Each additional 500 sq. R. or portion thereof -- <br />Limited Energ~ <br />Each Manufactured Home or <br /> Modular Dwelling Service or Feeder <br /> <br /> Res C.o~t <br /> <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 Fe~devs (Does not include branch Circuits, see section D) <br /> <br /> I <br /> 200 amps or less x $65.00 = S <br /> <br /> ~Fmnllyl~r~gF~:Sq.B~. -- 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 A 1 for Plan Review <br />C. Investigation Fee (if required) <br />D. Reinspecfion 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 />($62.501hr, minimum one hour) $ __ <br />G. Inspection Outside Normal Business Hours, <br />($62.50/hr, minimum two hours) $ __ <br />H. Induslxial Plant ($62.50/hr) $ __ <br /> <br />TOTAL AMOUNT DUE <br /> <br />$__ <br />$ <br />$ <br /> <br />/07/,2.. <br /> <br /> <br />