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FOR CITY USE ONLY <br />Received 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 /> Project Description: <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 /> Contra~or: <br /> <br /> Mailing Address: <br /> <br /> City: State: Zip: <br /> Phone: <br /> <br /> Contractor License No.: <br /> <br /> Supervisor License No.: <br /> <br /> Signature of Supervising Elect~cian: <br /> <br />2B. FOR OWNER INSTALLATION <br /> <br /> Property Owner: (please prinO <br /> <br /> Mailing Address: <br /> <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 os a construction contractor if the <br />structure is sold or offered for sale before or upon completion. If 1 <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 °f the c°n l~~ S/OD <br /> <br />3. PLAN REVIEW SECTION <br /> <br />Marion County does not require a plan review. We will provide plan <br />r~view service if you complete Section 5B and submit two (2) sets of <br />plans and specifications with this app cation. <br /> <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 en~r total in Al) <br /> <br /> Number of Inspections per permit allowed <br /> A. Residential Per Unit Service Included: <br /> Items Cost (each) Sum <br /> lO00sq, ti. orless -- x $110.00=$ 4 <br /> Eaehaddifional500sq. ft. or portion thereof -- x $20.00=$ <br /> Limited Energy ~ x $30.00 = $ I <br />~,,F~ach Manufactured Home or <br />Modular Dwelling Service or Feeder ~ x $52.00 -- $ 2 <br /> B. Services or Feeders (Does not include branch Circuits, ~ee section D) <br /> lastallation, Alteration or Relocation <br /> 200 amps or lcss -- x $65.00=$__2 <br /> 201amps to AO0 amps -- x $80.00--$__2 <br /> 40l amps to 600 amps -- x $130.00=$___2 <br /> 601 ampsto 1000amps -- x $170.00 =$ 2 <br /> Over 100{3 amps or volts -- x $390.00 = $ <br /> Reconnect Only -- x $55.00 = $ 2 <br /> <br /> 5. FEES <br />,~,"~"Ai' Enter total of fees from Sec.~4 <br /> ~ A2. Add State Surcl~arge ...~0 ~x Al) <br /> · SUBTOTAL <br /> <br /> B. Enter 30% of line A 1 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 /> K Inspection for which no fee is specifically indicated, <br /> ($62.50thr, minimum one hour) <br /> G. Inspection Outside Normal Business Hours, <br /> ($62.50/hr, minimum two hours) <br /> H. Industrial Plant ($62.50gar) <br /> <br />TOTAL AMOUNT DUE <br /> <br /> <br />