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FOE CITY USE ONLY <br />Received By: ~ Date: <br />Zoning. By: City: <br />Reaeipt #: Amount: $ <br /> <br /> ELECTRICAL PERMIT APPLICATION <br /> Please complete all Sections, I through 5 <br /> <br />LOCATION OF INSTALLATION~.L.~d~'~,.~-~] --~-~0~ <br />Parcel ID: <br /> <br />Si~Add~ss: ~ ~, ~ <br />City: ~~ Zip: ~ <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EI~PIRE IF WORK <br />IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INFORMATION <br /> <br />Propeay Owner: (plec~e prinO <br /> <br />Iviailing Address: <br />City: State: 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 contracto~ I <br />understand that I must register as a construction contractor if the <br />structure is sold or offered for sale before or upon completion. If 1 <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 />Owner's Signature: <br /> <br />3. PLAN REVIEW SECTION <br /> <br /> Marion County does not r~quire a plan review. We will provide plan <br /> review service ff you cora~lete Section 5B and submit two (2) sets of <br /> plans and spec ficat oas w th th s applicat on. <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 Service Included: <br /> l~ms Cost (each) Sum <br /> 1000sq, ft. orless -- x $110.00=$ 4 <br /> Each additional 500 sq. ft. or portion thereof -- x $20.00 = $ -- <br /> Limited Energy -- x $30.00 = $ 1 <br /> Each Manufactured Home or <br /> Modular Dwelling Service or Feeder -- x $52.00 = $ -- 2 <br /> B. Services or Feeders (Does not include branch Circuits, see section D) <br /> Installation, Alteration or Relocation <br /> 200 amps or less -- x $65.00 = $ <br /> 201amps to 40O araps -- x $80.00=$__ <br /> 401 amps to 600 amps -- x $130.00 = $ -- <br /> 601 ampsto 100~amps -- x $130.00 =$ <br /> Over 1000 amps or volts -- x $390.00 = $ <br /> Reconnect Only -- x $55.00 = $ <br /> <br />N/C <br /> <br />5. FEES <br /> A 1. Enter total of fees from Sec. ~ <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. Reinspectioo Fee ($50.00) <br />E. Additional Plan Review ($62.50tttr, <br />minimum one-half hour) $ __ <br />F. 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, n~nimum two hours) $__ <br />H, Industrial Plant ($62.50/hr) $ __ <br /> <br />TOTAL AMOUNT DUE $__ <br /> <br />MC 15-34 Rev 9,98 <br /> <br /> <br />