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FOR CITY USE ONLY <br />Received By: Date: __ <br />Zoning By: City: <br />Receipt #: Amount: $ <br /> <br />I ELECTRICAL PERMIT APPLICATION <br /> Please complete all Sections, 1 through $ <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />PERMITS ARE NON. TRANSFRRABLE AND EXPIRE IF WORK <br />IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br />WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />~FORMATION <br /> <br />Property Owner: (please print) <br />Mailing Address: <br /> <br />City: State: Zip: <br /> <br />I am the PROPERTY OWNER and own, reside in, or will reside in <br />the compltted 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· ltl <br />hire subcontractors, I will hire only subcontractors registered with <br />the Construction Contractors Board. ltl change my miad and do <br />h~re 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 /> Marion County does not require a plan review. We will provide plan <br /> review service if you complete Section 5B and submit two (2) sets of <br /> plans and specifications w th this app cat an. I <br /> I <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 /> Number of InspeCtions per permit allowed -- <br />A, Residential Per Unit Service Included: <br /> <br />1000 sq. ft. or less <br />Each additional 500 sq. ft. or portion thereof <br />Limited Energy <br />Each Manufactured Home or <br /> Modular Dwelling Service or Feeder <br /> <br /> Items Cost (each) Sum <br /> x $110.00 = $__4 <br /> x $20.00=$__ <br />-- x <br /> <br />$52.00--$__2 <br /> <br />B. Services or Feeders (Does not include branch cirCuits, see section D) <br /> Installation, Alteration or Relocation <br /> <br /> Fitttbtmc~citcuit { x $50,00=$ %,~ <br /> <br /> 5. FEES <br /> <br /> A2. Add State Surcharge (·05% x Al) <br /> SUBTOTAL <br /> <br /> B. Enter 30% of line A1 for Plae, Review <br /> C. Investigation Fan (if required) <br /> D. Ralnsgection Fee ($50.00) <br /> E. Additional Plan Review ($62.50/hr,. <br /> minimum one-half hoar) $ __ <br /> F. Inspection for which no fee is specifically indicated, <br /> ($62.50/hr, minimum one hour) <br /> <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 />MC 15-34 Rev 9/98 <br /> <br /> <br />