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FOR crrY ~ ONLY <br />Received By: Date: <br />Zoning By: City: <br />Receipt #: __Araount: <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, 1 through 5 <br /> <br /> PERMITS ARE NON-TRANSFERABI~ 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 /> <br />Signature of Supervising <br /> <br />2B. FOR OWNER INSTALLATION <br />Property Owner: (please print) <br /> <br />Ma[ling 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 be my own general contracton I <br />understand that I must register as a construction contractor if the <br />structure is sold or offered for sale before or upon completion, lf l <br />hire subcontractors, I will hire only subcontractors registered with <br />the Construction Contractors Boar~ If I change my' mind and do <br />hire a general contractor who is registered with the Construction <br />Contractors Board~ I will immediately noti~ Marion County of the <br />name of the contractor <br /> <br />3. PLAN REVIEW SECTION <br /> <br /> Marion County does not rcqalrc a plan review. We will provide plan <br /> review service if you complete Section 5B and subralt two (2) sets of <br /> plans and specifications with tiffs application. <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 24 HR Inspection Line 3734427 FAX 588-7948 <br /> <br />4. FEE SCHEDULE (complete and enter total in Al) <br /> <br /> Number of Inspections per permit allowed <br /> A. Residential Per Unit S~rvic~ Included: <br /> <br /> I~ms Cost (each) Sum <br />1000sq. ft. orless -- x $110.00=$ 4 <br />Each additional 500 sq. ft. or portion thereof -- x $20.00 = $ -- <br />Limited Energy -- x $30.00 = $ I <br />Each Manufactured Home or <br />Modular Dwelling Service or Feeder -- x $52.00 = $ 2 <br /> <br />B. Services or Feeders (Does not include branch Circuits, see section D) <br /> Installation, Alteration or Relocation <br /> 200 amps or less __ x $65.00 = $ <br /> 201 amps to 400 amps -- x $80.00 = $ <br /> 401 amps to 600 amps -- x $130.00 = $ <br /> 601 ampsto 1000amps -- x $170.00 =$ <br /> Over I000 amps or volts __ x $390.00 = $ -- <br /> Reconnect Only __ x $55.00 = $ <br /> <br />NIC <br /> <br />5. FEES Al. Enter total of fees from Sec. #4 <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. Reinspection 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 hoars) <br />H. Industrial Plant ($62.50/hr) <br /> <br />TOTAL AMOUNT DUE <br /> <br /> <br />