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FOR CITY USE ONLY <br />Received By: .Date: <br />Zoning By: .City: <br />Receipt #: Amount: $ <br /> <br />I ELECTRICAL PERMIT APPLICATION <br /> Please complete all Sections, 1 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 />WORX IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INFORMATION <br /> <br />Mailing Address: <br />City: State: Zip: <br />Phone: <br /> <br />Contractors Board No.: <br />Contractor License No.: <br />Supervisor License No.: <br /> <br /> Signature of Supervising Electrician: <br /> <br />2B. FOR OWNER INSTALLATION <br /> <br /> Property Owner: (pleaseprlnt)Ot~tl,~Oj;(~ <br /> Mailing Address: INq3 <br /> <br /> I am the PROPERTY OWNER and own, reaide <br /> the completed structure and will be my own general contractor I <br /> understand that I must register as a construction contractor if the <br /> structure is sold or offered for sale before or upon completion. If 1 <br /> hire subcontractors, I will hire only subcontractors registered with <br /> the Construction Contractors Boatrg 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 /> owne.,ssi tare: <br /> <br />3. PLAN REVIEW SECTION <br /> <br /> County does not require a plan review. We will provide plan <br /> Marion <br /> review service if you complete Section 5B and submit two (2) sets of <br /> plans and specifications with this app cat on. <br /> <br />MC 15-34 Rev. 9/99 <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 <br /> <br />4. FEE SCHEDULE (complete and enter Iota1 in Al) <br /> <br /> FAX 588-7948 <br />q4-d7qOc/ <br /> <br />__ x $52.00=$__ <br /> <br /> Items Cost (each) Sum <br />1000sq. ff. orless __ x $110.00=$ 4 <br />Each additional 500 ~, ft. or pertion thereof -- x $20.00 = $ -- <br />Lhnitad Energy __ x $30.00 = $ -- I <br />Each Manufactured Home or <br />Modular Dwelling Service or Feeder 2 <br /> <br />B. Services or Feeders (Does not include branch Circuits, see sectien D) <br /> Installation, Alteration or Relocation <br /> 200 amps or less Ox $65.00 = $ ~_~E~2 <br /> 2011tmpsto40Oarngs -- x $80.00=$ 2 <br /> 401 arngs to 600 amps -- x $130.00 = $ 2 <br /> 601 araps~i000araps __ x $170.00=$__.2 <br /> Over 1000 amps or volts -- x $390.00 = $ 2 <br /> Reconnect Only --. x $55.tl) -- $ --. 2 <br /> <br /> Each branch circuit q~ ~ x $3.00 = $ <br /> TOTAL $ __ <br /> <br />S. FEES Al. Enter total of fees from Sec. <br /> A2. Add Sta~ Surcharge (.07% xAI) <br /> <br />SUBTOTAL <br /> <br />B. Enter 30% of llne 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 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 ($62.50thr) <br /> <br />TOTAL AMOUNT DUE <br /> <br />$ <br />$ <br /> <br />$__ <br />$ <br />$__ <br />$ <br /> <br /> <br />