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crrY O.N .Y <br />R~:eived By: .Date: <br />Zoning By: City: <br />Receipt #: Amount: $. <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through $ <br /> <br />1. LOCATION OF INSTALLATION <br />Panel ID: <br /> <br />cityLAu_ ~ t) ~ i I ~- zip: q ~ .~...~ ~ <br />ParcelOwner: ~10/,~ Gt~l~Ol, O <br />Phone: <br /> <br />Cross S~.et/Div~ions: <br /> <br />ProjectDescfiption: ~/\e..-.-r ]~Se,~.4~f <br />PERMFI~ AP.F. 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 />C°ntra~t°r: G ~' ~~ -~. ~t~_. <br /> <br />Property Owner: (please print) <br />Mailing Address: <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 he my own general contracwr 1 <br />understand that I must register os a construction contractor ~f the <br />structure is soM or offered for sale before or upon completiot~ 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 registered with the Construction <br />Contractors Board, I will immediately notify Marion County of the <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 <br />review service if you complete Section 5B and submit two (2) sets of <br />p ins and specifications w th this app cation, <br /> <br />MC 15-34 R~v 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 />FEE SCHEDULE (complete and enter total in Al) <br /> <br />Limited Energy <br /> <br /> Items Co~t (each) Sum <br /> x $110.00 = $__4 <br /> x $20.00=$__ <br />-- x $30,00=$__1 <br /> <br />-- x $52.00=$__2 <br /> <br />B. Service~ or Feeders (Does not include branch Circuits, see sectiaq D) <br /> <br />Installation, Alteration or Relocation <br />200 amps or less <br />201 amps te400 amps <br />401 amps to 600 amps <br />601 amps to 1000 amps <br />Over 1000 amps or volts <br />Reconnect Only <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 $55.00=$__2 <br />Temporary Services/Feeders o~ <br />Installation, Alterations, or Rel <br /> <br /> TOTAL $ ~"' <br /> <br />Co <br /> <br /> $. FEES <br /> O~aA 1. Enter total of fees from Sec. ~. ] $~ <br />~,~ ~A~Sm~S~e(.05%xA1) ~ 3~ $~ <br /> <br /> E, ~di~on~ PI~ R~view ($62.50~, <br /> ~nim~ ~lf ho~) $.~ <br /> R ~s~fion for w~ch no fee is s~ific~ly in~ted, <br /> ($62,5~, ~m~ o~ houO $.~ <br /> G. Ins~fion ~ide No~ B~iness Ho~, <br /> ($62.5~, ~m~ ~o ho~) $.~ <br /> H. Indus~ Pl~t (~2,50~) :~~ <br /> <br />TOTAL AMOUNT DUE <br /> <br /> <br />