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FOR CITY USE ONLY <br />Received By: -- _Date: -- <br />Zoning By: ~City: <br />Receipt #: Amount: $. <br /> <br /> ELECTRICAL PERMIT APPLICATION-~ <br /> Pleas~ all Sections, l through 5 <br /> <br />L LOCATION OF INSTALLATION <br /> <br /> Parcel ID: <br /> <br />City: ~ Zip: <br />Parcel Owner:' <br /> <br /> E rrs, E NON:T NSrE ANO EXnEE Ir ] <br /> NOT ST~T~ WITHIN 1~ DAYS OF ISSUANCE OR IF I <br /> <br />lA. CONTRACTOR INFORMATION <br /> <br />Contractor: <br /> <br />Mailing Address: <br /> <br />City: State: Zip: <br />Phone: <br />Fax: <br /> <br /> ~ontmc~ors Board No.: <br /> <br />Contractor License No.: <br /> <br />Supervisor License No.: <br /> <br />Signature of Supervising Electrician: <br /> <br />2B. FOR OWNER INSTALLATION <br /> <br />1 ~ t~ PROPER~ OWN~ ~d own, ~side i~ or will ~side in <br />st~cm~ is soM or offend for sale b~o~ or ~n co~leaon, lf l <br /> <br />Contr~tors B~ I will i~edi~ely noti~ Ma~on Coun~ of t~ <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 /> Numbe~ of Inspections per permit allowed -- <br />A. Pa~dm~l Per Unit Service Included: <br /> <br />1000 sq. fL or le~s <br />Each additional 500 sq. ft. or portion thereof -- <br /> <br />~. FEES <br />Al. Enter total of fees from Sec. g4 $.~ <br />A2. Add State Surcharge (.05% x Al) $.__ <br /> <br /> SUBTOTAL $ .__ <br /> B. Enter 30% of line Al for Plan Review $.__ <br /> C. Investigation Fee (if required) $.__ <br /> D. Reinspection Fee ($50.00) $.__ <br /> E. Additional Plan Review ($62.50/hr, <br /> minimum one-half hour) $__ <br /> F. Inspection for which no fee is specifically indicated~ <br /> ($62.50/hr, minimum one hour) $.__ <br /> G. Inspection Outside Normal Business Hours, <br /> ($62.50/hr, minimum two hours) <br /> H. Industrial Plant ($62.50/hr) <br /> <br /> Cos~ (each) Sum <br />-- x $110.00=$ 4 <br /> x $20.00 = $__ <br />-- x $30.00=$__1 <br /> <br />-- x $52.00=$ 2 <br /> <br />TOTAL AMOUNT DUE <br /> <br /> <br />