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" ~ FOR 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 $ <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />Parcel ID: <br /> <br />P~el Owner,. <br /> <br />PERMITS ARE NON. TRANSFERABLE AND EXPIRE 1F 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 /> <br /> MaiYmg Address: <br /> City: State: Zip: <br /> <br /> Co~lractors Board No,: <br /> <br />Contractor License No.: <br /> <br />gui:revisor License No.: <br />Signature of Supervising Electrician: <br /> <br />2B. FOR OWNER INSTALLATION <br /> Property Owner: (pleasepHnO ~._r~~ <br /> MailingAddress:~[Jq( ~m I~ ~ ~ <br /> <br /> I am t~ PROPER~ OWNER and own, reside in, or will mside in <br /> <br /> stmctum is sold or offered for sale befom or upon compleaon, lf l <br /> the Constmction Contractors BoaM. ~1 c~nge my mind ~d do <br /> Contractors B~M. I will ~mediately not~ Marion Coun~ of the <br /> <br />3. PLAN ~V~W SECTION <br /> <br /> review semi~ if you complete S<tion 5B aM sabot two (2) ~m of <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 3734427 FAX 588-7948 <br /> <br /> 4. FEE SCHEDULe, (complete and enter total in Al) qq~' <br /> Number of Inspections per permit allowed -- <br /> A. R~identinl Per Unit Servie~ Included: <br /> Items Cost <br /> 1000 sq. fi. or less 7~:$ Sam <br /> Each additional 500 sq. ft. or pelti~ x $20.00 = $ <br /> <br /> Mod~i; o~ F~der x $52.00 =$__2 <br /> 200 amps or leas / x <br /> <br /> Each branch circuit /~'~ x $3.00: $ <br /> <br /> On~woFamilyl)wffilnglrv*:Sq. Feet -- x $ .09--$__ <br /> <br />FEES <br /> Al. Enter total of fees from Sec. g4 <br /> A2. Add State Surcharge (.07% x Al) <br /> <br />SUBTOTAL <br /> <br />B. Enter 30% of line A 1 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 indicated, <br /> ($62.50/hr, minimum one hour) <br />G. Inspection Outside Normal Business Hours, <br /> ($62.50/hr, minimum two hours) <br />H. IndusUial Plant ($62.50/hr) <br /> <br />TOTAL AMOUNT DUE <br /> <br />$ 0 <br /> <br />$ <br />$ <br />$ <br /> <br />$ <br />$ <br /> <br /> <br />