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FOR CITy US~ fONLY <br />Receiv~]~By; ~/ Date: <br />Zoning By: City: <br />Receipt #: Amount: $ <br /> <br />I ELECTRICAL PERMIT APPLICATION <br /> Please complete all Sections, 1 through 5 <br /> <br />1. LOCATION OF INSTALLATION <br />Parcel ID: <br /> <br />Zip: <br /> <br />Parcel Owner: <br /> <br />Phone: <br /> <br />PERMITS AR~NON-TRANSFERABLE AND £XPIR£ IF WORK <br />IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br />WORK IS SI]SPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INFORMATION <br /> <br />Contractor License No.: <br /> <br />Supervisor License No.: <br /> <br />Signature of Supervising Etectriciaa:~~ <br /> <br />2B. FOR OWNER INSTALLATION <br /> <br /> Property Owner. (please p~inO <br /> <br /> Mailing Address: <br /> <br /> City: State: Zip: <br /> <br />I am the PROPERTY OWNER and own, reside in, or wilt reside in <br />the completed structure and will be my own general contractor. I <br />understand that I must register as a construction contractor if the <br />structure is soM or offered for sate before or upon completion. If 1 <br />him subconm~ctors, I will hire only subcontractors registered with <br />the Construction Contractors BoartL If 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 require a NOTICE <br />review service if you complete Se <br />plans and specifications with this EFFECTIVE 7-1-99 <br /> STATE SURCHARGE CHANGE <br /> FROM 5% TO 7% <br />MC 15-34 Rev 9~98 <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) qq, 0 6 7 e,~ <br /> <br /> Number of Inspections per permit allowed <br />A. R~sldenttal Per Unit Service Included: <br /> Items Cost (each) Sum <br />1000sq. ft. orless -- x $110.00=$ 4 <br />Each additional 500 sq. ft. or potion thereof -- x $20.00 = $ <br />Limited Energy -- x $30.00 = $ __ 1 <br />Each Manufaciur~d Home or <br />Modular Dwelling Service or Feeder -- x $52.00 = $ 2 <br />B. Services or Feeders (Does not tedude branch Circui~ see section D) <br /> Installation, AIteratiofi or Relocation <br /> 200 amps or less ~ x $65.00 = $ 2 <br /> 201amps to 400 amps -- x $80.00=$__2 <br /> 401 amps to 6~O amps -- x $130.00=$__2 <br /> 601 amps to 1000 soaps -- x $170.00 = $ -- 2 <br /> Over 1000 amps or volts __ x $390.00 = $ -- 2 <br /> Reconn~tOnly -- x $55.00=$__2 <br /> <br />$. FEES Al. Enter total of fees from See. g4 <br /> <br /> A2. Add State Surcharge (.05% x Al) <br /> <br />SUBTOTAL <br /> <br />B. Enter 30% of llne Al for Plan Review <br />C. Investigation Fee (if required) <br />D. Reinspeetion 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 <br /> ($62.50/hr, minimum one hour) <br />G. Inspection Outside Normal Business Hours, <br /> ($62.50/hr, minimum two hours) <br />FI. Industrial Plant ($62.50~hr) <br /> <br />TOTAL AMOUNT DUE <br /> <br /> <br />