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FOR CITY U'~SE ONLY Received By: Date: Zoning By: ~ity: Re~ip~ ~. -- Amount: $__ p~a~CTRICAL PERMIT .a~PLICATION e complete all Sections, I through 5 MARION COUNTY BUILDING INSPECTION 3150 Lancaster Dr. NE - Suite C Salem, Oregon 97305 ////ff ~.~ ~b~/~/~00~ -, 4:30pm 24 HR Inspection Line 373-4427 FAX 588-7948 1. LOCATION OF INSTALLATION Site Address: ] Pau:~l Owner: Phone: Cross Street/Directions: PERMi~I~3 IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE OR IF WORK IS SUSPENDED FOR 180 DAYS. 2A. CONTRACTOR INFORMATION Supervisor License No.: 2B. FOR OWNER I~STALLATION Prope~ff Owner: (please prinO Mailing Address: City: Stale: Zip: I am the PROPERTY OWNER and own, reside in, or will reside in ~he completed structure and will be my own general contractor. I understand that I rnu~ register as a construction contractor if the structure is sold or offered for sale before or upon completion. If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors Board. If l change my mind and do hire a general contractor who is registered with the Construction Contractors Board, I will immediately noti~ Marion County of the name of the contractor. Owner's Signature: 3. PLAN REVIEW SECTION Marion Coumy does not require a plan review. We will provitte plan review service if you complete Section 5B and submit two (2) sets of I plans and specifications wi~h this application. MC 15-34 Rev 9/98 Number of Inspections per pem~it allowed -- Items Cost (each) Sum ft. orless -- x $110.00 =$___4 q. ft. or portion thereof -- x $'20.00=$__ x $30.00--$__1 Each Manufactured Hom~ or Modular Dwelling Service or F-~det -- x $52.00 = $__ 2 B. Services or F~,d~rs (Does not include branch Circuits, see s~cfl~o D) 401 amps to 600 amps 601 amps to 1000 amps Over 1000 amps or volts Reconnect Only Temlmrary Ser~ce~FeedeFs -- x $65,00=$__2 x $80.00=$__2 -- x $130.00=$ 2 -- x $170.00 = $. 2 -- x $390.00 = $. 2 -- x $55.00=$__2 -- x $45.00=$__2 -- x $55.00=$__.2 -- x $110.00=$__.2 -- x $3.00=$ $50.00 = $ ~ ~ $3.00=$__ One/l~o Fm~ffiy Dw~li~ Fe~ Sq. Feet -- x $55.00=$__2 -- x $55,00=$__2 __ x $55.00--$ 2 -- x $50.00=$__ -- x -- x $62.50fnr = $__ -- x $ .09 =$__ N/C FEES Al. Emer total of fees from Sec. #4 A2. Add State Surcharge (.05% x Al) SUBTOTAL B. Enter 30% of line A1 for Plan Review C. Investigation Fee (if required) D. Reiaspecfion Fee ($50.00) E. Additional Plan Review ($62.50/hr, minimum one-half hou0 $ __ E Inspection for which no fee is specifically indicated, ($62.50/hr, minimum one hour) $ G. Inspe. clion Outside Normal Business Hours. ($62.50far, minimum two hours) $ __ $ H. Industrial Plant ($62.50far) TOTAL AMOUNT DUE