Laserfiche WebLink
~OR CITY USE ONLY <br />Receive~ By: Date: <br />Zoning By: .City <br />Receipt #: Amount: $ <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, l thrOugh 5 <br /> <br />1. LOCATION OF INSTALLATION <br />Ipoxcel ID: <br />c ty:/d r rcc : z p: c, o9. <br /> Owner: <br /> parcel <br /> <br /> PE~ITS ARE NON. T~NSFE~B~ AND EXPI~ IF WOrK <br /> IS NOT START~ WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WOR~ IS ~USPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INFORMATION <br /> <br /> Contractor: <br /> <br /> Mailing Address: <br /> <br /> City: State: Zip: <br /> <br />Phone: <br /> <br />Fox: <br /> <br />Contractors Board No.: <br /> <br />Signature of Supervising Electrician: <br /> <br />2B. FOR OWNER INSTALLATION <br /> Property Owner: (please£~nt)~O~ <br /> Mailing Address: /qg~7 <br /> <br /> at~ture ia soM or offend for $ale befo~ or u~n completiom lf l <br /> Contractora Boad, I will ~diateO ~t~' Marion Cou~ of the <br /> <br />3. PLAN ~V~W SE~ION <br /> <br /> M~on County d~s not require a plan ~view. We will provide plan <br /> <br />MC 15-34 Rev 9/98 <br /> <br /> MARION COUNTY BUILDING INSPECTION <br /> 3150 Lancaster Dr. NE - Suite C <br /> Salem, Oregon 973(15 <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 Service Included: <br /> <br />1000 sq. fl, or less <br />Each additional 500 sq. ft. or portion thereof <br />LimitEd l~nergy <br />Each Manufactured Home or <br /> Modular Dwelling Servic~ or Feeder <br /> <br />Items Cost(each) Sum <br />-- x $110.00=$ 4 <br /> x $20.00= $ <br />-- x $30.00= <br /> <br /> -- x $52.00=$ <br />B. Se~rvices or Feeders (Does not nidude branch Circuit~ see secflon D) <br /> Installation, Alteration or Relocation <br /> 200 amps or less -- x $65.00=$__2 <br /> 201ampsto400amps -- x $80.00=$ . 2 <br /> 401 amps to 600 ~mps -- x $130.00 = $ 2 <br /> 601 amps to 1000 zanps -- x $170.00 = $ 2 <br /> Over 1000 amps or volts -- x $390.00 = $ 2 <br /> Re~onn~tOnly -- x $55,00=$__2 <br /> <br />8. FEES <br /> A l. Enter total of fees from Sec. #4 <br /> A2. Add State Surcharge.~ x Al) <br /> ,07 <br /> <br />SUBTOTAL <br /> <br />B. Enter 30% of l~ne At for Plan Review <br />C. Investigation Fee (if required) <br />D. R(mspecfion Fee ($50.~0) <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 />13. Inspection Outside Normal Business Hours, <br />($62.50/hr, minimum two hours) $ __ <br />H. Indusffial Plant ($62.50/hr) $ __ <br /> <br />TOTAL AMOUNT DUE <br /> <br /> <br />