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FOR CITY USE ONLY <br />Received By: <br />~ Zoning By: .City: <br />', Receipt #: Amount: $ <br /> <br /> ELECTRICAL PERMIT APPLICATION <br /> Please complete all Sections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br /> Parcel ID: <br /> <br />Cross Strecb~hcctions: <br /> <br />PERMIT~ ARE NON. TRANSFERABLE AND EXPIRE IF WORK ] <br />IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br />WORE IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CO~CTOR INWORMATION <br /> <br />Mailing Address: <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. 1 <br />underswnd that I must register as a construction contractor ~f the <br />structure is sold or offered for sale before or upon completion. If I <br />hire subcontractors, I will hire only subcontractors registered with <br />the Construction Contractors Board. If I change my mind and do <br />hire a general contractor who is registered with the Construction <br />Contractors Boart~ I will immediately notO~y Marion County of tbe <br />name of the contractor, <br /> <br /> Owner's Signature: <br /> <br />3. PLAN REVIEW SECTION <br /> <br /> Marion County does not require a plan review. We will provide plan <br /> review service if you complete Section 5B and submit two (2) sets of <br /> plans and specifications with this application. <br /> <br />MC 15-34 Rev 9/98 <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 373-4427 FAX 588-7948 <br /> <br />4. FEE SCHEDULE (complete and enter total in Al)9 q--~'~6~ <br /> <br />L~d ~ <br /> <br /> Items Cost (each) Sum <br /> <br /> x $20.00 = $__ <br />-- x $30.00=$__1 <br /> <br />__ x $52.00=$__.2 <br /> <br />FEES <br /> Al. Enter total of fees from See. #4 <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 required) <br />D. Reinspection Fee ($50.00) <br />E. Additional Plan Review ($62.50/bx, <br /> minimum one-half hour) <br />E Inspection for which no fee is specifically indicated, <br /> ($62.50/hr, mlnimRm one hour) <br />G. Inspection Outside Normal Business Hours, <br /> ($62.50/hr, minimum two hours) <br />H. indasttial Plant ($62.50far) <br /> <br />TOTAL AMOUNT DUE <br /> <br />$ <br />$ <br />$ <br />$ <br /> <br /> <br />