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FOR CITY USE ONLY <br />Received By: ____~te: <br />Zoning By: City: <br />Receipt #: Amount: $ ,0 <br /> <br /> APPLICATION <br /> ELECTRICAL <br /> PERMIT <br /> incase concrete set.ns, t_t 0ugn $ <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 /> Number Of InsPections per I~nnit al!ow~d- <br />A. Residential Pet~ Unit Servl~ Included: <br /> , l~s ~t (e~h) <br />l~.fl.~rl~s ~ x $110.~=$ <br />~h a~itioflal 5~ ~: ff~ or ~ion ~of ~ x $20.~ ~ $ ~ <br /> <br />200 amps or less <br /> <br />e branch Clrtnflts, see setflon D) <br /> <br /> x $65.00 = $ 2 <br /> <br />201 amps to 400 amps <br />401 amps to 600 amps <br />Ovex!600 amps or I000 volts ~ "B" above <br /> <br />2A. CONTRACTOR INFORMATION <br /> <br />Mailing Addressi <br /> <br />City: <br /> <br />Phone: <br /> <br />Fax: <br /> <br />State: Zip: <br /> <br />Contractors Board No.i <br /> <br />-- x $55.00=$__2 <br /> x $110.00 =$ 2 <br /> <br />nurchase of S~rviee tn' F~der F~: f~tl~ <br /> <br />E. Miscellaneous (Service or Feeder Not Included) <br /> Each pump or i~igafion circle x $55.00 = $ 2 <br /> Each Sigfl or Outhne Lighting -- x $55.00=$__2 <br />Signal Circuit(s) or a Limited Energy <br />Panel, Alteration or Extension -- x $55.~0 = $ , 2 <br />F. Each additional Inspection <br />over the allowable in any of the <br /> <br />SUBTOTAL <br /> <br />s. FEES <br /> Al. Enter total of fees from Sec, #4 <br /> A2. Add state Surcharge (.05% x Al) <br /> <br />B. Enter 30% of line A1 for Plan Re~'iew <br />C. Investigation Fee (if required) <br />D. Reinspection Fee ($50.00) <br />E. Additional Plan Review ($6Z50/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. Industrial Plant ($62.50fiar) <br /> <br />Contractor License No.: <br /> <br />Supervisor License No.: <br /> <br />Signature of Supervising Electrician: <br /> <br />opertOR OWNER INSTALLATION <br /> <br /> yOwnev. Coleaseprint) <br /> <br />TOTAL AMOUNT DUE <br /> <br />Malhag Address: ~[~ ~g~0y' /~TA <br /> <br />the Co~leted st~tu~ ~ will ~ m~ own ge~ral contracto~ 1 <br /> <br />st~ctu~ is soM or offend for sale b~o~ or apon completio~ lf l <br />him su~ontractors, I will him only subco~ractors registe~d with <br /> <br />Contractors Boa~ I will immediately not~ Ma~on Coun~ of the <br /> <br />3· PLAN REVIEW SECTION <br /> <br />Marion County does not require a plan r~view. We will provide plan <br />review service if you complete Section SB and submit two (2) ~ts Of <br />plans and specifications with this application. <br /> <br />MC 15-34 Rev 9/98 <br /> <br /> <br />