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iF OR CITY USE ONLY <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 /> I <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />City: ~E.'I"~'t 't" Zip: <br />Parcel Ownex: ~ ~ <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 INFORMAl'ION <br /> <br />Property Owner: (please pffnt) <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 as a construction contractor ~f the <br />structure is sold or offered for sale before or upon completio~ If l <br />hire subcontractors, I will hire only subcontractors registered with <br />the Construction Contractors Board. If I change my mind and do <br />hire a general contractor who is registered with the Construction <br />Contractors Board, I will immediately notify Matqon County of the <br />name of the contractor. <br /> <br /> Owner's Signature: <br /> <br />3. PLAN REVIEW SECTION <br /> <br /> Ma~on Cm!nty does no~ require a plan review. We will provide plan I <br /> rewew service if you complete Section 5B and submit two (2) sets of [ <br /> plans and specifications with this application. I <br /> <br />Mc is- <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 /> Cost (each) Sum <br /> <br /> x $20.00 = $__ <br />__ x $30.00=$__1 <br /> <br />__ x $52.00=$ 2 <br /> <br />B. Services or Feeders (Does not include branch Cimli~ see section D) <br /> Installation, All. ration or Rela~ttion <br /> 200 zmps or leas <br /> 201amps te 400 amps -- x $80.00=$__.2 <br /> 40I amps to 600 amps -- x $130.00 = $ <br /> 601 ampste 1000amps -- x $170.00=$__2 <br /> Ovet l000 amps or volts -- x $390.00=$__2 <br /> Reconnect Only __ x $55.00 = $ -- 2 <br /> <br /> Each branch ci~uit <br /> <br /> Signal Circuit(s) or a Limited I~ergy <br /> <br /> OnetTwoFamilyDwetlingF~:Sq.F~et -- x $ .09--$__ <br /> <br />FEES <br /> Al. Enter total of fees from Sec. #4 <br /> A2. Add State Surcharge (.0~r~ x Al) <br /> <br />SUBTOTAL <br /> <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 />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 /> TOTAL AMOUNT DUE $/t~. _~'~ <br /> <br /> <br />