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c,7 <br />[ ~l~ceived By: .Date: <br />~Zoning By: City: <br />[ R~eipt ~: .Amount: $. <br /> <br /> ELECTRICAL pERMIT APPLICATION I <br /> Please complete all Sections, 1 through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br /> Parcel ID: <br /> <br />City: ~ L) ~-0 f"G~. 0~. Zip: <br />Parcel Owner: <br /> <br /> Phone: <br /> <br /> Cross Street/Directions: .-~ .l~ <br /> <br /> PmjectDescription: [t~'T~LL. ]~l~l~::~C]'bk.~t,. SI~AJ <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 /> Cont~or Ucense No.: q~ ~ <br /> Supervisor License No.: ,~ Cl- <br /> Signature of Supervising Electrlciml:~ <br /> <br />2B. FOR OWNER INSTALLATION <br /> <br />Property Owner: (please print) <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 soM 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 notify Marion County of the <br />name of the contractor <br /> <br /> Ownex's Signature: <br /> <br />3. PLAN REVIEW SECTION <br /> <br />pans and spec ficat ons w th this app cation, <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 (comolete and enter total in Al)qq-oa,~'aO <br /> <br />E. Miscellaneous (Se~4ce or Feeder Not lnduded) <br /> Each pump or inigation circle x $55.00 = $. <br /> Each Sign or Outline Lighting ] x $55,00 = $ <br /> Signal C~reult(s) or a Limited Energy <br /> <br /> Oue/'l~oFanglyDwelllngFee:Sq. Feet __ x $ .09=$ <br /> <br />5. FEES Al. Enter total of fees from Sec. ~4 <br /> A2. Add State Surcharge (.05% x Al) <br /> <br />SUBTOTAL <br /> <br />B. Enter 30% of line Al for Plan Review <br />C. Investigation Fee (if requited) <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/hr, minimum one hour) <br />G. Inspection Outside Normal Business Hours. <br /> ($62.50~hr, minimum two hours) <br />H. Indusuial Plant ($62.50/hr) <br /> <br />TOTAL AMOUNT DUE <br /> <br />$ <br />$ <br /> <br />MC 15-34 Rev 9~98 <br /> <br /> <br />