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FOR CITY USE ONLY <br />~ Rec~xved By: Date: <br />~ Zoning By: City: <br />~ Receipt #: Amour: <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, t through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />Cross StreeqDirectinns: <br /> <br />2A. CONTRACTOR INFORMATION <br /> <br /> Co.tractor License No.: <br /> <br /> Supervisor Liceuse No.: /~/q ,~ <br /> Sigmature of Supervising Electrician:~ <br /> / - <br />2B. FOR OWNER INSTALLATION <br /> <br />Property Owner: (pfea~e print) <br /> <br />Mailing Address: <br /> <br />City: Siate: Zip: <br /> <br />I am the PROPERTY OWNER and own, reside in, or wilt reside in <br />the Completed structure and will he my own general contractor. I <br />understand that I must register as a construction contractor if the <br />structure is soM or offered for sale before or upon completion. Iii <br />hire subcontractors, I will hire only subcontractors registered with <br />the Construction Contractors Board. Iii change my mind and do <br />hire a general co~itracWr who i~ registered with the Construction <br />Contractors Board, I will immediately notify Matqon County of tbe <br /> <br />Owner;~ Signaturei <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 /> 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 />FEE SCHEDULE (e~mplete and ~nter ~ in Al) <br /> <br /> Number of Inspections per [grmit allow~l <br /> <br />1000 sq. fl. or less <br />Each additional 500 sq R. or pelion thea~of <br />Limited Energy <br />Each Manufactured Home or <br /> Modulsr Dwelling Service or Feadet <br /> <br />Items Cost ~egh) Sum <br /> x $110,00 = $ a <br /> x $20.~0 = S <br /> x $30.00 = $ ] <br /> <br />x $52.00 = $ 2 <br /> <br />$65.~0 = $ <br />$80,00 = $ <br />$130,00 = $ <br />$I70.00=5 <br />$390.00 = $ <br />~5.00~=~$ <br /> <br />$45,00 <br />$55.00 = $ <br />$ll0.00 = $ <br /> <br />x $50.00 = $ <br />x $3.00 = $ <br /> <br />x $55.00 = $ 2 <br />x $55.00 = $ 2 <br /> <br />x $55.00 = $ 2 <br /> <br /> x $50.00=$_ <br /> <br /> x $100.00 = $ <br /> <br /> x $62.50/hr = $ <br />One/l~n) Family I)wdBng Fee: Sq. Feet x $ .09=$ <br />Dwelling-- --Permit Labels (For Single Family Dwe~ings Only) N/C ' <br />OTHER, as required by the Building Official $ <br /> · TOTAL $ <br /> <br />¸5. <br /> <br />FEES <br /> Al. £~ter total Of fees from Sec. #4 <br /> A2. Add State Surcharge (.05% X Al) <br /> <br />SUBTOTAL <br /> <br />B. Enter 30% of line A1 for Plan Revigw <br />C. Investigation Fee (if required) <br />D. R¢inspection Fee ($50.00) <br />E. Addffional Plan Reg'iew ($62.50/1g, <br /> minimum one-half hour) <br />E Inspection for which no fee is specifically indicated, <br /> ($62.50far, minimum one hour) <br />G. Inspection Outside Normal Bus'mess Hours, <br /> ($62.50/hr, minimum two hours) <br />H. Industrial Plant ($62.50/hr) <br /> <br />TOTAL AMOUNT DUE $.__ <br /> <br />MC I5-34 Rev 9/98 <br /> <br /> <br />