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FOR CITY USE ONLY <br />Rec~w ed By: Dare: <br />Zoning By: City: <br />Receipt #: Amount: <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br />Parcel ID: <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 /> C°ntract°r: ~_(~ ~A ~ ~ P"~ <br /> <br />Fax: <br /> <br />Contractors Board No.: <br /> <br />Contractor License No.: <br /> <br />Supervisor License No.: <br /> <br />Signature of Supervising Electrician: <br /> <br />2B. FOR OWNER INSTALLATION <br />P~pe~y Owner: (please print) k <br /> ,, <br /> <br /> Mailing Address: <br /> <br />City: Stare: 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 contracto~ 1 <br />understand that l must register as a constntction contractor if the <br />structure is sold 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 irnntediately notify Marion County of the <br />name of the contracto~ <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 /> <br /> MARION COUNTY BUILDING INSPECTION <br /> 3150 Lancaster Dr. NE - Suite C <br /> Salem, Orego~t 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 /> Number of Inspections per permit allowed <br />A. Residential Per Unit Service Included: <br /> Items Cost (each) Sum <br /> <br /> 200 amps or less '/ x $65.,00=$ <br /> <br />5. FEES Al. Enter total of fees from Sec. g4 <br /> <br /> A2. Add State Surcharge~% 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 ($62.50f~r, <br /> minimum one-half hour) <br />F. Inspection for which tto fee is specifically incgtcated, <br /> ($62.50/hr, minimum one hour) <br />G, Inspection Outside Normal Business Hours, <br /> ($62.50/hr, minimum two hours) <br />H. Industrial Flant ($62.50/hr) <br /> <br />TOTAL AMOUNT DUE <br /> <br />$ <br />$ <br /> <br /> <br />