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FOR CrI'¥ 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 />I 1'~Te~iDA~ION OF INSTALLA'rION <br /> <br /> Parcel Owner: <br /> <br /> Project Description: <br /> <br />PERMITS ARE NON. TRANSFERABLE AND EXPIRE IF WORE <br /> IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORE IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INFORMATION <br /> <br /> Contractor: <br /> <br /> Mailing Add~ess: <br /> <br /> City: State: Zip: <br /> Phone: <br /> <br /> Contractors Boa~d No,: <br /> <br />Contractor License No.: <br />Supervisor License No.: <br /> <br />ay Owner: (please print) <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 />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 subcontractors, I will hire only subcontractors registered with <br />the Construction Contractors BoaM. 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 contractor. <br /> <br /> Owner's Signature: <br /> <br />3. PLAN REVIEW SECTION <br /> <br />pans and specifications with this application. <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 permit allowed <br />A. Residential Per Unit Servte~ Included: <br /> Rems Cost (each) Sum <br />lO00sq, ft. orless -- x $110.00=$ 4 <br />Eachaddltional5OOsq. ft. or porfion thereof __ x $20.00=$ <br />Lhnited Energy -- x $30.00 = $ 1 <br />Each Manufactured Home or <br />Modular Dwelling Service or Fc~der <br /> <br /> __ x $52.00=$ 2 <br />Services or Feeders (Does not include branch Circuits, see section D) <br />Installation, Alteration or Relocation <br />200 amps or less __ x $65.00 = $ 2 <br />201amps to 400 amps __ x $80.00=$ 2 <br />401 amps to 600 amps __ x $130.00=$ 2 <br />601 ampsto 1000amps __ x $170.00--$ 2 <br />Over I000 amps or volts __ x $390.00 = $ -- 2 <br />Reconnect Only -- x $55.00 = $ 2 <br /> <br />Ol~lP~pemllyDwellh~gFee:Sq. Feet -- 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 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 />E 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 ($62.50/hr) <br /> <br />TOTAL AMOUNT DUE <br /> <br />$ <br />$ <br /> <br />$ <br /> <br /> <br />