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FOR CITY USE ONLY <br /> R~[reived ~: .Date:_ <br /> Zoning By: City: <br />i Reeeipt #: ______.~_Amount: $ <br /> <br /> ELECTRICAL PERMIT APPLICATION <br /> Please complete all Sections, 1 through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br /> Parcal ID: <br /> <br />SiteAddre~s: t~t~ /~ 7 <br />City: ~ei/e~. · Zip: <br />Parcel Owner: <br /> <br />Cross Street/Directions: <br /> <br />IS NOT STATED ~THIN 180 DAYS OF ISSU~CE OR IF <br />WORK IS SUSPE~ED FOR 180 DAYS. <br /> <br />,/ <br /> <br />2A. CONTRACTOR INFORMATION <br /> <br />Con~xac~rs Board No.: <br />ContracWr License No.: <br /> <br /> Supervisor License No.: yf~t~4 <br /> Signature of Supervising Electri¢ian_.'~ <br /> <br />2B. FOR OWNER INSTALLATION <br /> <br /> Property Owner: (please pffnt) <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 1 <br />understand that I must register as a construction contractor if the <br />structure is sold or offered for sale before or upon completior~ 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 Construction <br />Contractors Board, I will immediately notify Marion County of the <br />name of the contractor, <br /> <br />Owner's Signature: <br /> <br />PLAN REVIEW SECTION <br /> <br />Marion County does not <br />review service if you co~ <br />plans and specifications <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 /> MAR/ON 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. FEB SCHEI)ULE (c~mplete and enter total In Al) ~]~-- 007~¢ <br /> <br /> Number of Inspections per permit allowed -- <br />A. Residential Per Unit Sam Included: <br /> <br />1000 sq. fi. or less <br />Each additional 500 sq. ft. or portion thereof -- <br />Limited Energy <br />Each Manufactured Home or <br /> Modular Dwelling Se~ice or Feeder <br /> <br /> Items Cost (each) Sum <br />-- x $110.00=$__4 <br />x $20.00=$__ <br />-- x $30.00=$__1 <br /> <br /> x $52.00 = $ 2 <br /> <br />B. Servk~ or Feeders (Does not include br~nch Circuits, see section D) <br /> Installation, Alteration or Relaeation <br /> 200 amps or less -- x $65.00 = $__ <br /> <br /> One/l~FmnilyDwe[gngFee:Sq. Feet -- x $ .09=$__ <br /> <br />N/C <br /> <br />5. FEES Al. Enter total of fees from Sec. O, <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. Reinspecfion 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 />