Laserfiche WebLink
FOR CITY USE ONLY <br />ReceiSn~ By: .Date: <br />Zoning By: City: <br />Receipt #: Amount: $ <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, 1 through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />Site^ddt. ss: 7 <br />City: /~t~r"Oyt~l-. <br />parcel Owner: <br /> <br />Zip: <br /> <br />CrossStre~tJDirections: / .~/C.. [ <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 />2A. CONTRACTOR INFORMATION <br /> <br /> Signature of Supervising Electrician~ <br /> <br />21). FOR OWNER INSTALLATION <br /> <br /> Property Owner: (please p~qnO <br /> <br />Mailing 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 contractor 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, lf l <br />hire subcontractors, I will hire only subcontractors registered with <br />the Construction Contractors Board, If I change my mind and do <br />hire a general contractor who is registered with the Co~truction <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 requir <br />review mice if you complete <br />plans and specifications with tt <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 - ~-:30pm 24 HR Inspection Line 373-4427 FAX 588-7948 <br /> <br /> FEE SCHEDULE (complete and enter total in Al) <br /> <br /> Number of Inspections pr permit allowed -- <br />A. Reddential Per Unit Service lneludzd: <br /> Items C~st (each) Sum <br /> <br />Each additional 500 sq. ft. or potion thereof -- x $20.00 = $__ <br />Limited Energy -- x $30.00 = $__ I <br />Each Manufactured Home or <br />Moduts~ Dwelling Service or Feeder -- x $52.00 = $__ 2 <br />B. Services or Feeders (Does not il~lude branch Circuits, s~e section D) <br /> 2~O amps or less -- x $65.00=$__2 <br /> <br /> Over 1000 amps or volts ~ x $390.00 = $ -- 2 <br /> <br /> First branch circuit -- x $50.00 = $ -- <br /> <br />E. Miscellaneous (Service or Feeder Not lnduded) <br /> <br /> above, per inspt~lon -- x $50.00 = $ -- <br /> <br /> Onerl~FanalyDv~e~lngltte:Sq.F~:t -- x $ .09=$__ <br /> <br /> OTHER, as ~alr~d by the Building Official $ -- <br /> TOTAL $ -- <br /> <br />$. FEES Al. Enter total of fees from Sec. g4 <br /> <br /> A2. Add State Surcharge (.05% x Al <br /> <br />B. Enter 30% of line A1 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 />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 />H. Industrial Plant ($62.50/hr) <br /> <br />TOTAL AMOUNT DUE $ <br /> <br /> <br />