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...................................... ~, -, : , - - ~ ~dARION COLVNTY BUILDING INSPECTION <br />' h : k]~f] 3150 Lancaster Dr. NE - Suite C <br />11 Receiv$dmR CITYBy:USE ONLY Date: ~ ~ ........... ' )~ Salem, Oregon .97305 '" <br />~Zon~ng By: City: 8:00am - 4:30pm 24 HR Inspection Line 373-4427 FAX <br />,: R pt #: mount: S_ ,' 0 C 1 0 cq <br />· ' MARION COUNTY <br />.................................... 4. F~E SCH~D~E (complete ~ e~te£ total In AI) <br /> ELECTRICAL PERMIT APPLICATIOI~I[DI~]G INSPEC] )N Number °f lnspeeti°ns per permit all°wed -- <br /> Please complete all Sections, I through 5 ! A. Residential per Unit Service Included: <br /> <br />1. LOCATION OF INSTALLATION <br /> <br /> Parcel ID: <br /> <br /> Site Address: <br /> <br /> parcel Owner: <br /> <br />Zip: <br /> <br />Cross SmmtiDi~ctines: <br /> <br />Project Description: <br /> <br />PERMITS ARE NON.TRANSFERABLE AND EXPIRE IF WORK <br />IS NOT STARTED WITHIN i80 DAYS OF ISSUANCE OR IF <br />WORE IS SUSPENDED FOR 180 DAYS. <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, l <br />understand that I must register as a construction contractor if the <br />structure is sold or offered for sale before or upon completiot~ lf l <br />hire subcontractors, I wilt hire only subcontractors registered with <br />the Construction Contractors Board.4f I change my mind and do <br />hire a general contractor who is regt~tered with the Construction <br />Contractors Board, I will imr~diately notify Marion County of the <br /> <br />3. PLAN REVIEW SECTION <br /> <br /> Marion County does not require a plan review. We will provide plan <br /> r~view service if you complete Section 5B and submit two (2) sets of <br /> plans and specifications with tiffs application. <br /> <br /> Items Cost (each) Sum <br />1000sq. R. orless -- x $110.00=$ 4 <br />EachaddiffonalS00sq. ft. or portlon thereof __ x $20.00=$ <br />Limh~d Energy __ x $30.00 = $ -- 1 <br />Each Manufactured Home or <br />ModularDwellingServiceotFeeder -- x $52.00=$ 2 <br />B. Services or Feeders (Does not Include branch Circall.% se~ section D) <br />Installation, Alteration or Rdoeation <br />200 amps or less <br /> 201amps to 400 amps -- x $80.00=$ 2 <br /> <br /> Each branch circuit <br /> <br /> Om/l~Faml~'l~nal~Fm~l. Pm -- x $ .09=$__ <br /> <br /> OTHER, a~ r~qnired by the Building Off. al $ <br /> xoTnr $ 3`/.00 <br /> <br />S. FEES Al. Enter total of fees from Sec. g4 <br /> A2. Add State Surcharge (.05% x Al) <br /> <br />SUBTOTAL <br /> <br />B. Enter 30% of llne Al for Plan Review <br />C. Investigation Fee (if requimti) <br />D. Reinspecfion 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 indieate~ <br /> ($62.50?ar, minimum one hour) <br />G. Inspection Outside Normal Business Hours, <br /> ($62.50/hr, minimum two hours) <br />H. Industrial Plant ($62.50/hr) <br /> <br />TOTAL AMOUNT DUE <br /> <br />$ .%.3c} <br /> <br />MC 15-34 Rev 9198 <br /> <br /> <br />