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..................................... MARION COUNTY BUILDING INSPECTION <br />FOR ~:rr¥ USE ONLY 3150 Lancaster Dr. NE - Suite C <br /> Received By: .Date: Salem, Oregon 97305 <br /> <br /> Zoning By: ~City: 8:00am - 4:30pm 24 HR Inspection Line 373-4427 FAX 588-7948 <br /> <br />IELECTRICAL PERMIT APPLICATION NUmber 0f i~specti°ns per permit allowed -- <br /> Please complete all Sections, I through $ ~ ~ , A. Residential lee t~all S~rvlee Indude& <br /> Items C~t (each) Sum <br /> 1000 sq. ft. el' less · x $110.00 = $ 4 <br /> L LOCATION OF INSTALLATION Each additional 500 sq. ft. or potlio~ theI~Of X $20.00 = $ <br /> ParcelID: LimitedEnergy -- x $30.00=$__1 <br /> Each Manufactured Hom~ or <br /> Site Add'ss: ', ' M~i~ Dwelling Service 6r Feeder <br /> B. Services or Peeder~ (Dees not thd~ branch Circuits, see ~mt~n D) <br /> Installation, Alan or Rdoeaflon <br /> z0o ~mps o, <br /> 201ampsto400amps -- x $80.00--$ 2 <br /> 401 ampstot00 amps x $130.00=$ 2 <br /> 601 amps to 1000 amps <br /> Over 1000 amps or volts -- x $390.00 -- $ 2 <br /> <br /> . : InMalla~lo~ AItJatlons, ~r:RelOeafloa <br /> <br />~~IpERM~rS'O~NON, rR~VSF~L~ND£XP~RE~FWORIcl 401 a~pstot0Oamps x Sn0.00 =$ <br /> <br /> ISNOTS1'ARTEDWFfH[NISODAY$OFISSUANCEORI'F I ' : Ovcrt00~anpsoxl000voltsse~ B aboe <br /> WORK'ISsUSPENDED :FOR i80 DAYS. ' : ' I D, Branch Clrcult~ <br /> <br />2A. CONTRACTOR INFORMATION <br /> <br />Mailiag Address: <br /> <br />City: State: Zip: <br /> <br />Contrac~m BOard No:: <br /> <br />Supervisor Liqense No.: <br /> <br />Signature of Supervialag Electrician: <br /> <br />2B. FOR OWNER INSTALLATION <br />Property Owner: (please print) ~/~1/' ~ 1 : <br />Mailing Address:. ~,~r ,~/.,~.~ ~ ~ <br />City:~fft,~//./~.~ State: ~ Zip~ ~,7"~.~" <br /> <br />I am the PROPERTY OWNER and own, reside ~n, or will reside in <br />the ComPleted strUCture and will be my o~n~eneral contractor. 1 <br />understand tha~ ! mttst register as a construction contraL'tor if the <br />structure is sold or offered for sale before or upon completion. Ill <br />hire subcontractors, I will hire only subcontractors registered with <br />the Construction Contractors Board. lf l change my mirut and do <br />hire a general contractor Who is registered with the Construction <br />Contractors Board, I will immediately notify Marion County of the <br />name of the contractoe <br /> <br /> x $3,00 = $ , <br /> <br />E. MIzeeilaneom (Service or Feeder Not Included) <br /> <br /> Dwelling Permit Labels fFor Single Family Dwenln? Only) NiC <br /> XOTAr s <br /> <br />Owner's Signature: <br /> <br />3. PLAN REVIEW SECTION <br /> Marion County does not require a plan review. We will pr0vide plan ] <br /> review service if you complete Section 5B and submit two (2) sets of <br /> p aris and spec fications w th th s app icafion. <br /> <br />MC 15-34 Rev 9/98 <br /> <br />5. FEES Al. Enter total of fees from Sec. g4 <br /> A2. Add State Surcharge (:05% x Al) <br /> <br />suBTOTAL <br /> <br />B, Enter 30% of line A! for Plan Reyiew <br />C. Investigation Fee (if required) <br />D. Reinspecfion Fee ($50.00) <br />E. Additional Plan Review ($tZ50/hr, <br /> minimum one-half hour) ' <br />E Inspection for which no fee is specifically indicated, <br /> ($62.50Par, minimum one hour) <br /> <br />$ <br /> <br />G, Inspection Outside Normal Business Hours. <br />($62.50/hr, minimum two hours) $ <br />H. Industrial Plant ($62.50/hr) <br /> TOTAL AMOUNT DUE ( $~1~ <br /> <br /> <br />