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FOR OITY USE'ONLY <br /> Received By: Date: <br /> Zoning By: City: <br /> Receipt #: Amount: $ <br /> <br /> ELECTRICAL PERMIT APPLICATION <br /> Please complete all Sections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION / <br /> <br />Parcei'l~ <br /> <br /> ~,0\~J) ~,C~ MARION COUNTY BUILDING INSPECTION <br />ti.l, ^ ~',t 3150 Lancaster Dr. NE - Suite C <br />~"~ q* {r'~0 ~ Salem, Oregon 97305 <br />'-' ~,d 8:00am - 4:3Opm 24 HR Inspection Line 3734427 FAX 588-7948 <br /> <br /> Number of lnspo:fions per permit allowed <br /> A. Residential Per Unit Service Included: <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK <br />IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br />WORK IS SUSPENDED FOR 180 DAYS. , <br /> <br />2A. CONTRACTOR INFORMATION <br />Gontra~tor: <br /> <br />State: Zip: <br /> <br />Mailing Address: <br /> <br />City: <br /> <br />Phone: <br /> <br />Fax: <br /> <br />Contractors Board No.: <br /> <br />Signature of Supervising Electrician: <br /> <br />2B. FOR OWNER INSTALLATION <br /> <br /> Mailing Address: ~,~7 6/~O~O~)~/ p~ <br /> <br /> I am t~ PROPER~ OWNER and own, mside in, or will <br /> t~ c~leted st~tu~ ~ will be my own generM co~to~ 1 <br /> u~ersta~ t~t I m~t mgister ~ a constru~ion contmctor [the <br /> st~tu~ is sold or offemd for sale befo~ or upon completio~ lf l <br /> ~ su~ontractors, I will hi~ on~ subcontractors ~gistemd with <br /> the Const~tion Contractors B~ lf l c~ge my ~nd a~ do <br /> hi~ a general contractor who is ~gistered with t~ Contrition <br /> C~tmcton Boa~ I will i~diuiely not~ Marion Coun¢ <br /> na~ of &e cont~to~ <br /> <br />Owner'~ 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 /> plans and specifications w th this app cation. <br /> <br /> Items Cost (each) <br />-- x $110.00=$__4 <br />:~ $20,00 = $__ <br />-- x $30.00=$ 1 <br /> <br />-- x $52.00=$__2 <br /> <br />B. Services or Feeders (Does not Include branch Circuits, see section D) <br /> Insmiludon, Alteration or Relocation <br /> 200 amps or less ~ x $65.00 = $ 2 <br /> 201amps to 400 amps -- x $80.00=$ 2 <br /> 401 amps to 600 amps -- x $130.00 = $ -- 2 <br /> 601 ampsto l~0amps -- x $170.00 =$ 2 <br /> Ov*r 1000 amps or volts -- x $390.00 = $ -- 2 <br /> <br />$3.00 =$~ <br /> <br />5. FEES <br /> Al. Enter total of fees from Sec. g4 $ <br /> A2. Add State Surcharge,,~t% x Al) $.__ <br /> ,O~ SUBTOTAL $ <br /> <br /> B. Enter 30% of line Al for Plan Review <br /> C. Investigation Fee (if required) <br /> D. Reinspeetion Fee ($50.00) <br /> E. Additional Plan Review ($62.5Whr, <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 Ouiside Normal Business Hours, <br /> ($62.50/hr, minimum two hours) $.__ <br /> H. Industrial Plant ($62,50/hr) $.__ <br /> <br />TOTAL AMOUNT DUE $.__ <br /> <br />MC 15-34 Rev 9/98 <br /> <br /> <br />