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FOR ~IT¥ USE ONLY <br />Reeeived 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 />Parcel ID: <br /> <br />Parcel Owner: <br /> <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 />lA. CONTRACTOR INFORMATION <br /> <br />Property Owner:~le~eprint) <br /> <br />State: Zip; <br /> <br />Mailing Address: <br />City: <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 if the <br />structure is sold or offered for sale before or upon completion~ If l <br />hire subcontractors, I will hire only subcontractors registered with <br />the Construction Contractors Board If l change my mind and do <br />hire a general contractor who is registered with the Construction <br />Contractors Boar& I will immediately notify Marion County of the <br />name of the contractor <br /> <br />Owner's Signature: <br /> <br />8:00am - 4:30pm <br /> <br />3150 Lancaster Dr. NE - Suite C <br /> Salem, Oregon 97305 <br /> 24 HR Inspection Line 373-4427 <br /> <br />3. PlaN REVIEW SECTION <br /> Marion County does not ~quire a plan review. We will provide plan I <br /> review se~ice if you complete Section 5B and submit two (2) sets of I <br /> plans and specifications with this application. I <br /> I <br /> <br /> MARION COUNTY BUILDING INSPECTION <br /> <br /> FAX 588-7948 <br />4. FEE SCHEDULE (complet~ and enter total in Al)7q~t~/~ <br /> <br /> Number of Inspections per permit allowed-- <br />A. Residential Per Unit Ser~ke Included: <br />Items Cost (each) Sum <br />1000sq. fi. orless -- x $110.00=$___4 <br /> <br /> Modular Dwelling Service or Feeder ] x $52.00 = $ ~ 2 <br /> <br /> On~TwoFamilyl)wdl~glre~:Sq. Fe~ -- x $ ,09=$__ <br /> <br />FEES <br /> Al. Enter total of fees from Sec. ~4 <br /> A2. Add State Surcharge (.05% x Al) <br /> <br />SUBTOTAL <br /> <br />B. Enter 30% of line A1 for Plan Review <br />C. Investigation Fee (if required) <br />D. Reinspectlon 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 indicated, <br /> ($62.50/hr, minimum one hour) <br />G. Inspection Outside Normal Business Hours, <br /> ($62.50/hr, minimum two hours) <br />H. Indus~al Plant ($62.50/hr) <br /> <br />TOTAL AMOUNT DUE <br /> <br />$ <br />$ <br />$ <br /> <br />$ <br />$ <br /> <br />MC 15-34 Rev 9,98 <br /> <br /> <br />