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]*OR CIfY USE ONLY <br /> ReCeived fly": Date: <br /> Zoning By: City: <br /> Receipt ~. Amount: $ <br /> <br />I ELECTRICAL PERMIT APPLICATION <br /> Pleas* complete all Sections, I through 5 <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 />L LOCATION OF INSTALLATION <br /> <br />City: Zip: <br />Parcel Owner:. <br /> <br />Phone: <br /> <br /> Cross StmetiDirections: <br /> <br />PERMITS ~ NON-T~SFE~B~ AND E~I~ IF WO~ <br />IS NOT STATED W~HIN 180 DAYS OF ISSU~CE OR IF <br />WORE IS SUSPENDED FOR 180 DA~. <br /> <br />~. CON~C~R INFO~TION <br /> <br />2B. FOR OWNER INSTALLATION <br />Pmporty Owner. (please print) <br /> <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 completed structure and will be my own general contmcto~ l <br />understand that I must register as a con$truction contractor if the <br />structure is sold or offered for sale before or upon completion, lf l <br />hire subcontractors, I will hire only subcontractors registered with <br />the Construction Contractors Board. lf l change my mind and do <br />hire a general contractor who is registered with the Construction <br />Contractors Board, I will immediately nat~, Marion County of the <br />nome of the contracto~ <br /> <br />Owner's Signature: <br /> <br />$.PLANREVlEWSECTION <br /> <br />Marion County do~ not require <br />review service if you complete S <br />plans and specifications with thi.~ <br /> <br />MC 15-34 Rev 9198 <br /> <br /> NOTICE <br /> EFFECTIVE 7-1-99 <br />STATE SURCHARGE CHANGE <br />FROM 5% TO 7% <br /> <br />4, FEE SCHEDULE (complete and enter total in Al) <br /> <br /> A. P.~sidentini Per Unit Service Included: <br /> <br /> Items Cost (each) Sum <br />1000sq. ft, orless -- x $110.00=$__4 <br />Each additional 500 sq. fl. or portion thereof -- x $20.00 = $ -- <br />Limited Energy -- x $30.00 = $ 1 <br />Each Manufactured Home or <br /> <br />Installation, Alteration or Relocation <br />200 amps or less <br />201 amps to 400 amps x $80,00 = $ <br />401amps to 600 amps -- x $130.00=$__ <br />601ampsto 1000amps -- x $170.00=$__ <br />Over 1000 amps or volts -- x $390.00 = $ -- <br />Reconnect Only -- x $55.00 = $ -- <br /> <br />5. FEES Al. Enter total of fees from ,gee. g4 <br /> A2. Add State Surcharge (.05% x Al) <br /> <br />SUBTOTAL <br /> <br />B. Enter 30% of line A 1 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/tu', minimum one hour) <br />13. 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 />