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FOR crrv USE ONLY <br />i Received By: .Date: <br />Zoning B~: .City: <br />Receipt g: Amount: $. <br /> <br />ELECTI~ICAL PERMIT APPLICATION <br />Please complete all Sections, 1 through 5 <br /> <br />· LOCATION OF INSTALLATION <br /> <br />Parcel ID: <br /> <br /> J <br /> <br />PE~ ~ NON-~NSF~B~ AND E~ IF WO~ I <br />IS NOT ST~D W~N 180 DA~ OF ISSUAN~ OR'IF [ <br />WO~ IS SUSPE~ FOR 180 DAYS. ] <br /> <br />~,. CONTRACTOR INFO~dA'FION <br /> <br /> Contractor: <br /> <br /> Mailing Address: <br /> <br /> City: State: Zip: <br /> Phone: <br /> <br /> Coni~actors Board No.: <br /> <br /> Supervisor License No.: <br /> <br /> Signature of Supe~ising Electrlelan: <br /> <br />2B. FOR OWNER INSTALLATION <br /> <br /> Propert~ <br /> M~iling Address: /q~7~ <br /> <br /> Contractors Boani I will immediately notify Marion County of the <br /> <br />MC 15-34 Rev 9/98 <br /> <br /> MARION COUNTY BUILDING INSPECTION <br /> 3150 Lancaster Dr. NE - Suite C <br />Salem, Oregon 973/)5 <br />8:00am - 4:30pm 24 HR Inspection Line 373-4427 FAX 588-7948 <br /> <br /> Nmnb~r of lnspecL{C~s p~r permit allowed -- <br /> A. Resld~attal Per Unit Servi~e lncloded: <br /> <br />I000 sq. fl. or leas <br />Each additional 500 sq. fl. or portion thereof -- <br />Limited Fawa~ y <br /> <br />Co~t (each) Sum <br /> $110.00 = $__4 <br /> $20.00 = $ -- <br /> $30,00=$__1 <br /> <br /> $52.00=$__2 <br /> <br /> . <br /> <br />O~t']~o Family I~ Fee: Sq. Fe~ <br /> <br />Al. Emer total of fees from Sec. ~ <br />A2. Add Sta~ Surcharge (.05% x Al) <br /> <br />Services or Feeders (l~es not Ine. lnda branch Circuits, see section D) <br /> <br />$65.00=$__2 <br />$80.00 = S__ 2 <br />$130.00=$__2 <br />$170.00 = $__2 <br />$390.00 = $__ 2 <br />$55.00 = $ ' 2 <br /> <br />-- x $55.00=$ 2 <br />-- x $110.00=$__2 <br /> <br />SUBTOTAL <br /> <br /> $3.00 = $ <br /> <br />$5o.0o = $ ~ <br /> $3.00 = $_~3~ <br /> <br />S55.00 = $ 2 <br />$55.00 = $ 2 <br /> <br />S55.00 = $ 2 <br /> <br />$50.00 = $ -- <br />$1~.0~ = $ -- <br /> <br />-- x $62.50/hr = $ <br />-- x $ .09=$ <br /> <br />N/C <br /> <br />B. Enmr 30% of line A1 for Plan ~¢view $_ <br />C. Investigation Fee (if requlwd~. $__ <br />D. Reinspection Fee ($50.00) $__ <br />E, Adc~ttional Plan Review ($62.50/hr, <br /> m~mmum one-half hour) ~' $ __ <br />E Inspection for which no fee is specifidal~ iadicatcd, <br />($62.50/hr, minimum one hour) $ __ <br />G. Inspection Outside Normal Business Hours, <br /> ($62.50/hr, minimum two hours) ,~, $ _~.Z~ <br />H. Indus~al Plant ($62.50/hr) i:" . <br /> TOTAL AMOUNT DUE. <br /> <br /> <br />