Laserfiche WebLink
TOR crl'Y ~SE ONLY <br />Rec~ved By: Date: <br />Zoning By: .City: <br />Receipt #: Amount: $. <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through $ <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />parcel Owner:. <br /> <br />Zip: <br /> <br />?hone: <br /> <br />Cross Street/Directions: / /~ O' <br /> <br />Project l~scfiption: ~,~L.~f ~t.~t'~O <br /> <br />IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br />WORK IS SUSPENDED FOR 180 DAY& <br /> <br />CONTRACTOR INFORMATION <br /> <br /> Supervisar License No.: <br /> Signature of Supervising Elec~ician: ~/~ <br /> <br />2B, FOR OWNER INSTALLATION <br /> <br /> Prope~ Owner: (please prinO <br /> <br />Mailing Addeess: <br />City: Sta~e: Zip: <br /> <br />I am the PROPERTY OWNER and own, reside in, or will reside in <br />the completed strucVarz and will be my own general contractor I <br />understand that I must register as a construction contractor if the <br />structure is sam or offered for sale before or upon completion, If l <br />hire subcont~ctors, I will hire only subcontractors registered with <br />the Construc6on Contractors Board If l change my mind and do <br />hire a genend contractor who is registered with the Construction <br />Contractors Board, I will imrtwdiately notify Ma~on County of the <br /> <br />Owner's Signature: <br /> <br />PLAN REVIEW SECTION <br /> <br />Marion County does not requi~ <br />review service if you complete <br />plans and specifications with ~ <br /> <br />MC 15-34 Rev 9/98 <br /> <br /> NOTICE <br /> EFFECTIVE 7-1-99 <br />STATE SURCHARGE CHANGE <br />FROM 5% TO 7% <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 3734427 <br /> <br />FAX 588-7948 <br /> <br />4. FEE SCHEDULE (complete and enter total in Al) <br /> <br />qq-- 0 7q L <br /> <br /> Items Cost (each) <br />__ x $110.00=$ <br />-- x $20.00=$__ <br />-- x $30.00=$__ <br /> <br />1000 sq. fl. or less <br />Each additional 500 sq. ff. or po~ion thereof <br />Limited Energy <br />Each Manufactured Home or <br /> Modular Dwelling Service or Feeder <br /> <br />Sum <br /> <br />Nec <br /> <br />-- x $52.00=$ <br /> <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 /> 201 amps to ~00 amps __ x $80.00 = $ <br /> ~O1 amps to 600 amps __ x $130.00 = $ <br /> 601 ampsto 1~00 amps x $170.00 =$__ <br /> Over 1000 amps or volts ~ x $390.00 = $ <br /> Reconnect Only -- x $55.00 = $ <br /> <br /> Onef~FamilyDwdlingF~-:Sq. Fcet -- x $ .09=$__ <br /> <br /> 2 <br /> 2 <br />2 <br /> <br />5. FEES <br />Al. Enter total nf fe~s from Sec. g4 <br />A2. Add State Surcharge (.05% x Al) <br /> SU TOT / <br />B. Enter 30% of line A1 for Plan Review <br />c. r. vas gmio. (ir qui d) / <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 /> ($62.50Par, minimum one hour) <br /> G.Inspection Outside Normal Business Hours. <br /> ($62.50/hr. minimum two hours) <br /> H. Industxial Plant ($62.50/hr) <br /> <br />TOTAL AMOUNT DUE $- <br /> <br /> <br />