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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 /> Please complete all Sections, 1 through $ <br /> <br />1. LOCATION OF INSTALLATION <br /> <br /> P0teel ID: <br /> <br />Project Description: <br /> <br />PERM1T~ ARE NON. TRANSFERABLE AND EXPIRE IF WORK <br /> <br />IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br />WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />CONTRACTOR INFORMATION <br /> <br />2B. FOR OWNER INSTALLATION <br />Property Ownec (please print) <br /> <br /> Mailing Address: <br /> <br />City: State: Zip: <br /> <br />I am the PROPERTY OWNER and own, reside in, or will reside in <br />the completed structure and will be my own general contractor. 1 <br />understand that I must register a~ a construction contractor if the <br />structure is sold or offered for sale before or upon completio~ lf l <br />hire subcontractors, I will hire only subcontractors registered with <br />the Construction Contractors Board. If l change my mind and do <br />hire a general contractor who is reglster~d with the Construction <br />Contractors Board, I will immediately notify Matqon 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 plan I <br />review service if you complete Section 5B and submit two (2) sets of <br />p aris and specificat OhS w th this app cation. <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 24HR Inspection Line 373-4427 FAX 588-7948 <br /> <br /> 4. FEE SCHEDULE (comple~ and enter total in Al) <br /> <br /> Number of Inspections per permit allowed -- <br />A, Residential Per Unit Service Included: <br />Items Cost (each) Sum <br />1000sq. fi. orless -- x $i10.00=$__4 <br />Each additional 500 sq. fi. or pottlon thereof -- x $20.00 = $ __ <br />Limited Energy __ x $30.00 = $__ 1 <br />Each Manufactured Home or <br />Modular Dwelling Service or Fe~der -- x $52.00 = $ 2 <br />B. Services or Feeders (Does not include branch Circuits, see section D) <br /> Installation, Altsration or Relocatim~ <br /> <br /> Each branch circuit / x $3.00 = $ <br /> <br />5. FEES Al. Enter total of fees bom Sec. ~ <br /> A2. Add State Surcharge (.05% x Al) <br /> <br />SUBTOTAL <br /> <br />B. Enter 30% of line Al for Plan Review <br />C. Investigation Fee (if required) <br />D. R(mspecfion Fee ($50.00) <br />E. Additional Plan Review ($62.50/hr, <br /> minimum one-half hour) <br />E 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 ($62.50/hr) <br /> <br />TOTAL AMOUNT DUE <br /> <br />$ Sq, go <br />$__ <br />$__ <br />$__ <br />$__ <br /> <br />$ <br /> <br />$__ <br /> <br />$__ <br />$__ <br /> <br /> <br />