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ii,OR CIT-~ ONLY USE <br /> Received By: .Date: <br /> Zoning By: City: <br /> Receipt #: Amount: $. <br /> <br /> ELECTRICAL PERMIT APPLICATION <br /> Please complete all Sections, 1 through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br /> parcel ID: <br /> <br />City: ~x~xO ~(~ <br /> <br /> ff' C <br />Cross Street/Directions: <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 />Contractor: <br /> <br /> Mailing Address: <br /> City: State: Zip: <br /> <br /> lax: <br /> <br /> C~teactor License No.: <br /> <br /> Supe~isor License No.: <br /> <br /> Signature of Supervising Electrician: <br /> <br />2B. FOR OWNER INSTALLATION <br /> <br /> ci,:/ voa state: O"o' <br /> I am t~ PROPER~ OWNER a~ ow~ ~si~ i~ or will ~s~e in <br /> <br /> Com~ctors B~ I will im~diately not~ Ma~on Co~ of t~ <br /> <br />3. PLAN RENEW ~ ...... <br />I M~on County d~ NO~CE <br />review ~iee if ye EFFECTI~ 7-1-99 <br />pl~s and s~ificat STATE SURCHARGE C~NGE <br /> ~OM 5% TO 7% <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 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. Resid~atial Per Unit Service Inc uded <br /> <br />1000 sq. ft. or less <br />Each additional 500 sq. ft. or potion thereof __ <br />Limited Energy <br />Each Manufactured Home or <br /> Modular Dwelling Service or Fcc~er <br /> <br /> Items Cost (each) Sum <br /> x $110.00 = $ 4 <br /> x $20.00 -- $ <br /> <br />__ x $30.00=$__1 <br /> <br />-- x $52.00=$ 2 <br /> <br />B. Servic~ or Feeders (Does not include branch Circuits, see section D) <br /> Installation, Alteration or Relocation <br /> 200 amps o~ less __ x $65.00=$__2 <br /> 201ampzto400amps -- x $80.00=$__2 <br /> 401 ampsto600amps -- x $130.00=$__2 <br /> 601 ampslo lO00amps __ x $170.00=$ 2 <br /> Over 10130 amps or volts __ x $390.00 -- $ __ 2 <br /> Reconnect Only -- x $55.00=$__2 <br /> Inst~llafio~ Alterations, or Relncation <br /> <br /> 201amps to 400 amps __ x $55.00=$ 2 <br /> ~O1 amps to 600 amps -- x $110.00 =$__2 <br /> <br /> a) Th~ f~e for b~nch circuits with the <br /> Each bnmch circuit -- x $3.00 -- $ __ <br /> <br /> Signal Circnit(s) or a Limited E~ergy <br /> <br />H. Iudustrtal Phmt -- x $62.50/hr = $ -- <br /> On~'l~oFamgyD,a~g~IF~;Sq.F~ -- x $ <br /> <br /> OTHER, ~s reqnired by the Building Official $ -- <br /> TOTAL $ -- <br /> <br />5. FEES <br />Al. Enter total of fees from Sec. g4 <br />A2. Add State Surcharge (.05% x Al) <br /> SUBTOTAL~ <br />B. Enter 30% of line A1 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 /> F. Inspection for which no fee is specifically indicate~"- <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 />