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FOR ~CITY U.S~E ONLY <br />Received By: Date: <br />Zoning By: City: <br />Receipt #: Amount: <br /> <br /> ELECTRICAL PERMIT APPLICATION <br /> Please complete all Sections, I through 5 <br /> <br />L LOCATION OF INSTALLATION <br /> <br /> Parcel ID: <br /> <br />Sit, Add.ss: Ir2.70 ~-w-d"z. ¼.,re: 'SE- <br /> <br />CrossStmeffl)irections: <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 /> Contractor: <br /> <br /> Mailing Address: <br /> <br />City: State: Zip: <br />Phone: <br />Fax: <br /> <br /> Supervisor License No.: <br /> <br /> Signature of Supervising Electrician: <br /> <br />2B. FOR OWNER INSTALLATION <br /> Pr°perty Owner:' (please "tint) t~ . ~...[g.~ ~-~'~ <br /> Mailing Address: ~6~0 ~L~'~'~'~ ~( <br />city: . ,b, ttc zip: <br /> <br /> I am the PROPERTY OWNER and own, reside in, or wdl 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 Boartt 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 />3. PLAN REVIEW SECTION <br />Marion County does n, NOTICE <br />review service if you c EFFECTIVE 7-1-99 <br /> plans and specification 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 - 4:30pm 24 HR Inspection Line 373-4427 FAX 588-7948 <br /> <br />4. FEE SCHEDULE (complete and enter total in Al) <br /> <br />MC 15-34 Rev 9/98 <br /> <br /> Number of Inspections per permit allowed <br />A, Residential Per Unit Service Included: <br /> Items Cost (each) Sum <br />1000 sq. fl. or I~ss -- x $110,00 -- $ 4 <br />Each additional 500 sq. R. or pertion thereof __ x $20.00=$__ <br />Limited Energy -- x $30.00 = $ -- 1 <br />Each Manufactured Home or <br />Modular Dwelling Service or Feeder t x $52.00 = $ --. 2 <br />B. S~rvices or Feeders (Does not include branch Circuits, see section D) <br /> <br />Installation, Alteration or Relocation <br />200 amps or less -- x $65.00 = $ __ <br />201amps to 400 amps __ x $80.~0=$ <br />401 amps to 600 amps -- x $130.~0 =$__ <br />601 ampsto 1000amps __ x $170.(30 =$ <br />Over 1000ampsorvolts -- x $390.00 =$ <br />Reconnect Only __ x $55.00 = $ <br /> <br />H. Industrial Plant -- x $62.50fa~ = $__ <br /> Onefl~o Famfly Dwelling Fee: Sq. Feet __ x <br /> Dwelling Permit Labels (For Single Family Dwellings Only} <br /> OTHER, as required by the Building Official $ __ <br /> TOTAL $ -- <br /> <br />N/C <br /> <br />5. FEES Al. Enter total of fees from Sec. g4 <br /> <br /> A2. Add State Surcharge (.05% x A1 <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 ($62,50/hr, <br /> minimum one-half hour) <br />E Inspection for which no fee is specifieall <br /> ($62.50/Ixr, minimum one hour) <br />G. Inspection Outside Normal Business Hours, <br /> ($62.50llu', minimum two hours) <br />H, Industrial Plant ($62.50/hr) <br /> <br />y ln~__ <br /> <br />TOTAL AMOUNT DUE $ <br /> <br /> <br />