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FOR CITY USE ONLY ~ 3150 Lancaster Dr. HE - Suite C <br /> Received By: Date: ~ \~'~ H~ /~ .4 ~flnn Salem, Oregon97305 <br /> Zoning <br /> By: <br /> City: <br /> ~Y ¥"'" ",t'~8~-4:S0pm 24 HR Inspection Liue 37~-4427 <br /> <br />...................................... t U LD N8 INSP <br /> ELECTRICAL PERMIT APPLICATION <br /> <br />1. LOCATION OF INSTALLATION <br />Parcel ID: <br /> <br />Cwss S~reet/Direc~ions: <br /> <br /> Project Des~ntmou 7'~ ~' <br /> <br /> PERMITS AR£ NON. TRANSFERABLE AND EXPIRE IF WORK <br /> 1S NOT STARTED WITHIN18O DAYS OF I$SUANCE OR IF I <br /> WORK IS SUSP~ENDED FOR 180 DA~ <br /> <br />2A, CONTRACTOR INFORMATION <br /> <br />RECEIVED co Y. .iNG INSPECTION <br /> FAX 588-7948 <br /> <br />Signature of SuPervising Electrician:" <br /> <br />2B. FOR O~rNER INSTALLATION <br /> <br /> Property Owner. (please print) <br /> <br /> City: State: Zip:' <br /> <br />I am the PROPERTY OWNER and own, reside in, or will reside in <br />the completed structure and will be my own general contracto~ I <br />underStand that I mu~t register as a construction contractor if the <br />structure is sold or offered for sale before or vpon completion, lf l <br />hire subcontractors, I will hire only subcontractors registered with <br />the Construction Contractors Board. lf l change my m/nd and do <br />hire a general contractor wh6 is registered with the Construction <br />Contractors Board, I will immediately noti~ Marion County of the <br />name of the contractot <br /> <br />OWner's Signature: <br /> <br />3. PLAN REVIEW SECTION <br /> Marion County does not require a plan review. We will prOvide plan [ <br /> review service if you complete Sectio~ 5B and submit two (2) sets of <br /> plans and specifications with this app Scat on. <br /> <br />A. Residential Per Unit Ser~tee Included: <br /> <br />1000 sq. fl. or less <br />Each additional 500 sq. fi. or ~x~.ion thereof <br />Limited Energy <br />Each Manufactured Home or <br /> Modular Dwelling Service or Feode~ <br /> <br /> Items Cost (each) Sum <br />__ x S110.00=$ 4 <br /> x $20.00 = $ <br /> x $30.00 = $ 1 <br /> <br />x $52.00 = $ 2 <br /> <br /> x $65.00=$___2 <br /> x $80.00 = $ 2 <br /> x $130.00 = $ 2 <br /> x $170.00 = $ 2 <br /> x $390.00 = $ 2 <br /> x <br /> <br />. x $~5.00 = $ 2 <br /> x $55.00 = $ 2 <br /> x $110,00=$ r 2 <br /> <br />x $3.00=$ <br /> <br />. x $50.00 <br />. x $3.0o <br /> <br />__ x $55.00=$ 2 <br />__ x $55.00=$ 2 <br /> <br />x $55~00 = $ 2 <br /> <br />-- x $50.00=$ <br /> <br />-- x $100,00=$ <br /> <br /> -- <br /> x $ .09=$ <br />Dwelling Permit Labels (For Single Fmlly Dwellfngs only) NR~ <br />OTHER, as ~.quired by the Building Hfllctal $ -- <br /> YOTAL $ <br /> <br />5. FEES Al. Enter wtal of fees from Sec. g4 <br /> <br /> A2. Add State Surcharge (.05% x Al) <br /> <br />suBTOTAL <br /> <br />B. Enter 30% of line A1 for Plan Review <br />C. Investigation Fee (if required) <br />D. Reinspection Fee ($50.00) <br />El 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 AMOUNTDUE <br /> <br />MC 15-34 Rev 9/98 <br /> <br /> <br />