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FOR Cfl~ USE ONLY <br />Received By: .Date: <br />Zoning By: .City: <br />i Receipt #: ~ount: $. <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sectiotts, l through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br /> Parcel ID: <br /> <br /> Site Address: t-~q~'~ /~_~ <br /> ci,y: / A vttl zip: q73z <br /> <br />Cross StreeffDirections: <br /> <br /> Project Desaliption: ~A~] ~/ ,~l ~9 ~. ~ <br /> <br />PERMITS ARE NON-~NSFE~ AND E~I*E IF WORK <br />IS NOT STATED ~THIN 180 DAYS OF ISSUANCE OR IF <br />WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONT~C~R INFECTION <br /> <br /> Su~imrLicenseNo,: ~ [ ~ -S <br /> Sig~at~ of Supe~ising Elec~ian: ~ ~ <br /> <br />2B. FOR O~R ~ALLATION <br /> <br />Property Owner:. (p/ease print) <br /> <br />Mailing Address: <br />City: <br /> <br />Stat~: 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 contractor. 1 <br />anderstand that I m~sst register as a construction contractor if the <br />structure is sold or oJfered for sale 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 Construction <br />Contractors Board, I will immediately notify Marion County of the <br />name of the contractor <br /> <br />3. pLAN REVIEW SECTION <br /> <br /> Marion County does not require a plan review. We will provide plan <br /> review service if you complete Section 5B and submit two (2) rets of <br /> plans and specifications with this app ication. <br /> <br />MC 15-34 Rev 9~8 <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 lnspe~tlons per permit allowed -- <br />A. R~sidential Per Unit Service Included: <br />  Cost (each) S <br />lO00 sq. ft. orless x $110.00 =$~ <br /> <br /> -- x $52.00=$ <br />Services or Feeder~ (Doez not include branch Circuits, see section D) <br />Installation, Alteration or Relocation <br />200 amps or less -- x $65.00 = $ -- <br />201amps to 400 amps -- x $80.00--$__ <br /> <br />2 <br /> 2 <br /> <br />2 <br />2 <br /> 2 <br /> <br /> 2 <br /> 2 <br />.2 <br /> <br />NIC <br /> <br />FEES <br /> Al. Enter total of fees from Sec. g~4 <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 <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 Oniside Normal Business Hours, <br /> ($62.50/hr, minimum two hours) <br />H. Industrial Plant ($62,50Par) <br /> <br />TOTAL AMOUNT DUE <br /> <br />$__ <br /> <br />$ <br />$__ <br /> <br />$__ <br /> <br /> <br />