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FOR cITY USE ONLY <br />~ Received By: .Date: <br />[ Zoning By: City: <br />~ Receipt #: .Amount: $ <br /> <br />IELECTRICAL PERMIT APPLICATION I <br /> Please complete all Sections, I through 5 <br /> <br />1. lOCATION OF INSTALLATION <br /> <br />P~cel Owuer: <br /> <br /> Cross Sueet/Directions: <br /> <br />[PERMII'~ ARE. NO3I.~RAIV'~FERABL2? AND EXPIR~ <br /> WORK <br />IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br />WOP. K I$ SglSPEIqDED FOR 180 DAY& <br />2A. CONTRACTOR II. FORMATION <br /> <br />Propezty Ovm~. (please <br />Mailing Address: <br />City: State: Zip: <br /> <br />I am the PROPERTY OWblER and own, reside in, or will reside in <br />the completed structu~ and will be my own general contractor. I <br />understand that I must r~gister as a construction contractor 0~ the <br />structure is sold or offered for sale before or upon completion~ If 1 <br />tdre subcontractor:;, I will hire only subcontractors registered with <br />the Construction Contractors BoaraL If l change my mind and do <br />hire a general contractor who is registered with the Construction <br />Contractors Boara~ I will immediately notify Marion County of the <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 pkan <br />review service if you complete Section 5B and submit two (2) sets of <br />plans and spec ficatiotla w th this app cation. <br /> <br />MC 15-34 Rev 9/98 <br /> <br /> MARION COUNTY BUILDIIqG INSPECTION <br /> 3150 Lancaster Dr. NE - Suite C <br />Salem, Oregon 97305 <br />8:00am - 4:30pm 24 HR Inspection Line 3~.~.-4427 F. AX 588-7948 <br /> <br /> 4. FEE SCHEDULE (complete and enter total in Al) <br /> <br /> Number of h~speetions per peemit allowed <br />A. Resbie~fl~l Per Unit ~ervice Included: <br /> <br /> Items Cost (each) Sum <br />-- x $110.00=$ 4 <br />-- x $20.00=$__ <br />-- x $30.00=$__1 <br /> <br /> $52.00=$__2 <br /> <br />Lin~ted Energy <br /> <br />FEES <br /> Al. Enter w~al of fnes from See, $$4 <br /> A2. Add State Surcharge 605% x Al) <br /> <br />SUBTOTAL <br /> <br /> $ <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 im:licated. <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 /> TOTAL AMOUNT DUE <br /> <br /> <br />