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FOR CITY USE ONLY <br />R~caived By: -~' Date: <br />Zoning By: City: <br />Receipt #: Amount: $ <br /> <br /> ELECTRICAL PERMIT APPLICATION <br /> Please complete all Secth~ns, l through 5 <br /> <br />1. LOCATION OF INSTALLATION(~. f~9~VeAO~ ~t,~ot~ot.,~', <br />parcel ID: <br /> <br />Cross Streel/D~reclions: <br /> <br />PERMITS ARE NON, TRANSFERABLE AND EXPIRE IF WORK ] <br />IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br />WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2~. COWI'IIAlYFOR INFORMATION <br /> Contractor: '~ \ ~,~-.~' <br /> <br /> Su~isor License No.: <br /> <br />Signature of Supervising Elecfficlan: <br /> <br />2B. FOR OWNER INSTALLATION <br />Pmpexty Owner: (please prinO <br /> <br />Mailing Address: <br />City; State: Zip: <br /> <br />I am the PROPERTY OWNER and own, reside in, or will residt in <br />the completed structure and will be my own general contractoL I <br />understand that I must register as a construction contractor if tbe <br />structure is sold or offered for sale before or upon completion. If 1 <br />hire subcontn~ctors, 1 will hire only subcontractors registered with <br />the Construction Contractors Board. Ill change my mind and do <br />hire a general contractor who is registered with the Construction <br />Contractors Board, I will immediately notify Ma~on County of the <br />name of tbe contractor. <br /> <br />Owner's Signature: <br /> <br />3. PLAN REVIEW SECTION <br /> <br /> Macon County does not require a plan review. We will provide plan <br /> Nview service if you complete Section 5B and subtuit two (2) rets of <br /> pans and spec ficatioas with th s application. <br /> <br /> MARION COUNTY BUILDING INSPECTION <br /> 3150 Lancaster Dn NE - Suite C <br /> Salem, Oregon 97305 <br />8:00am - 4:30pm 24 HR Inspection Line 3734427 FAX 588-7948 <br /> <br />4. FEE SCHEDULE (complete and enter total in Al) <br /> <br /> Number of Inspections per permit allowed -- <br /> <br />E <br /> <br /> -- x $52.00=$__ <br />Services or Feeders (Does not include branch Circuits, s~e section D) <br />Installation, Alteration or Relocation <br />200 maps or less __ X $~l~ = $ ~ <br /> <br />1 <br /> <br />2 <br /> <br />2 <br />2 <br /> <br /> 2 <br /> 2 <br /> <br /> NIC <br /> <br />$__ <br />$__ <br />$__ <br />$__ <br />$__ <br />$__ <br /> <br />$__ <br />$ <br /> <br />$ <br />$ <br /> <br />$__ <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. Entex 30% of line Al for Plan Re,~iew <br />C. Investigation Fee (if required) <br />D. Reinspection Fee ($50.00) <br />E. Adfflfional Plan Re¥1ew ($62.50far, <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, minimum two hours) <br />Hl Imiustfial Plant ($62.50/~') <br /> <br />TOTAL AMOUNT DUE <br /> <br />MC 15-34 Rev 9~8 <br /> <br /> <br />