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FOR CITY USE ONLY <br />Received By: Dat~: <br />Z~ning By: f2ity: <br />Receipt #: Amount: $ <br /> <br />ELEL-I'RICAL PERMIT APPLICATION <br />Please complete all Sections, I through $ <br /> <br />1. LO~ATION OF INSTALLATION <br /> <br /> Parcel ID: <br /> <br /> it# Address: <br /> <br />City: Zip: <br />Parcel Owner: <br /> <br />Description: <br /> <br />IPF~MITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK <br /> I$ NOT STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />~ CONTRACTOR INFORIVlATION <br /> <br /> Conuac~or: <br /> <br /> Mail/n8 Address: <br /> <br /> City: State: Zip: <br /> <br />Supervisor L~eense No.: <br /> <br />Signature of Supervising Elee~i¢ian: <br /> <br />s~ is sOM or ~e~d for s~e b~ or ~ co~o~ ff l <br />plus ~d ~ffic~ous w · ~ app~a~ou. <br /> <br />MC 15-34 Rev 9198 <br /> <br /> MAR/ON COUNTY BUILDING INSPECTION <br /> 3150 Lancaster Dr. NE - Suite C <br />Salem, Oregon 97305 <br />8:00am - 4:30pm 24 ]:~ Inspection Line 373.-4427 FAX 588-7948 <br /> <br /> 4. FEE SCHEDULE (¢~plete Ilmt anler tolal i~[l) <br /> <br /> Number of lnspeclio~ per permit allowed -- <br /> <br /> Items Cost (ezch) Sum <br /> __ x $110.00=$__4 <br /> __ x $20.00=$__ <br /> __ x $30.00=$__1 <br /> <br /> __ x $52.00=$__2 <br /> Services or Fe~d~rs (Do~z no~ Include branch Clr tail,s, see aectlon D) <br /> In~allaffon, Aide,lion or Reloca~ <br /> 200 ampz or less x $65.00 = $~ <br /> 201 amps to 400 amps ~t x $80.00 = ~.t~ 2 <br /> 401 amps to 600 amps x $130.00 = $ 2 <br /> 601amps te l000 amps -- x $170.00=$__2 <br /> Over 1000 amps or volts x $390,00 = $__ 2 <br /> <br />C. T~mporary Servio~/Ftn~dera <br /> <br /> 200 amps or lcss __ x $45.00=$__2 <br /> 201amps to 400 amps __ x $55.00=$__2 <br /> 401amps te 600 amps __ x $110.00=$__2 <br /> <br />D. Brm~l~ Circuits <br /> <br /> Oantl~oFanfltyD~m,~F~:Sq.F~ __ x $ .09=$ <br /> OTHER, as r~q~lml by the Buildln8 ~ $ <br /> <br />5. FEES <br />Al. Enter total of fees from Sec. 04 $ <br />A2. Add State Surcharge (.05% x Al) $ __ <br /> SUBTOTAL $ <br />B, Enter 30% of line A1 for plan Review $_~1 <br /> <br /> D. Reinsl~ctlou Fee ($50.00) <br /> E. Additional Plan Review ($62.50/hr, <br /> minimum one-half hour) $ <br /> F. Inspecton for which no fee is specifically indicated, <br /> ($62.50/hr, minimum one hour) $ __ <br /> G. Inspeetiou Outside Normal Business Hours, <br /> ($62.50/lu', minimum two hours) $ __ <br /> H./adus~al Plant ($62.50&r) $ <br /> <br /> <br />