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FOR CITY USE ONLY <br />! R~ived B~O Date: <br />Zoning By: .City: <br />Receipt #:. Amount: $. <br /> <br />IELECTRICAL PERMIT APPLICATION I <br /> Please complete all Sections, 1 through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />Cross Street/Directions: <br /> <br /> , , <br />PERMITS ARE NON. TRANSFERABLE AND EXPIRE IF WORK [ <br />IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE OR IF I <br />WORE IS SUSPF~IDED FOR 180 DAYS. I <br /> <br />2A. CONTRACTOR INFORMATION <br /> <br />I <br /> <br /> Owner's Signature: <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 complct~ S~ctioa 5B and submit two (2) sets of <br />pans a~d spec float oas w th th s app cat on. <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 3734427 FAX 588-7948 <br /> <br />4. FEE SCHEDULE (complete and enter total in Al) <br /> <br /> Number of Inspections per permit allowed <br />A. Residential Per Unit Service Included: <br /> <br />Items Cost (each) Sum <br />__ x $110.00=$ 4 <br />-- x $20.00=$ <br />-- x $30.00=$ I <br /> <br />-- x $52.00=$ 2 <br /> <br />200 amps or less / x $65.00=$ <br /> <br />Each pump or lrcigation ciacle /' x $5~/00 =$ ~ <br /> <br /> TOTAL-' ~ /!O <br /> <br />5. FEES Al. Enter tolal of fees from Sec. g4 <br /> <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 required) <br />D. Reinspection Fee ($50.00) <br />E. Additional Plan Review ($62.50thr, <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, Industrial Plant ($62.50/hr) <br /> <br />TOTAL AMOUNT DUE <br /> <br /> /lo,Ob <br /> <br />$__ <br /> <br />MC 15-34 Rev 9/98 <br /> <br /> <br />