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_DateO_7 L/_ - ,. <br /> · _ ' . t- <br />Zoning By: ~ _City: <br />Re, ce~pt #: Amount: $ , <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />PERMITS ARB NON-TRANSFERABLE AND EXPIRE 1F WORK <br />is NOr STARrEO wrrmN gSo oars or tSWANC O,, Ir I <br /> IS S SP*N, EO EOR ArS. . I <br />2A. CONTRACTOR INFORMATION <br /> <br /> Contractor: <br /> <br />Mailing Address: <br /> <br />City: <br /> <br />Phone: <br /> <br />State: Zip: <br /> <br />Conh~ctors Board No,: <br /> <br />Supervisor License No.: <br /> <br />Signature of Supervising Electrician: <br /> <br />2B. FOR OWNER INSTALLATION <br /> <br /> Prope~y Owner: (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 ge,emi contractor. 1 <br /> understand that I must register as a construction contractor ~f the <br /> structure is sold or offered for sale before or opon completior~ lf l <br /> hire subcontractors, I will hire only subcontractors registered with <br /> the Construction Contn~ctors BoarcL lf l change my mind and do <br /> hire a general contractor who is registered with the Construction <br /> Contractors Board~ l will immediately notify Marion County of the <br /> name of the contractor. <br /> <br />3. PLAN REVIEW SECTION <br /> <br /> Ma~on 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 I <br /> plans and specifications with this application. <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 /> .4. FEE SCHEDULE (c~nplete and ~t~r total in Al) <br /> <br /> N~a~r of I~.$pe~l. I~ 1~rm[t allowed <br /> A. R,sidenflai Per Unit Service Included: <br /> <br />B. Seoices or Feeders (Does not include branch Clr~lts, s~e s~:fian D) <br /> Installation, Alteration or Rdocatlon <br /> 200 maps or less -- x $65.00 = $ -- 2 <br /> 201 iunps to 400 amps x $80.00=$ 2 <br /> 401amps~6OOamp~ __ x $130.00=$.__2 <br /> 601amps to l000 amps -- x $170.(]0=$ 2 <br /> Over 1000 amps or volts -- x $390.00 = $ 2 <br /> Reconnect Only -- x $55.00 = $.__ 2 <br /> <br /> Installation, Alterations, or i~loealtan <br /> 20o.mm o~ I~ / x $~s.00 = S ~(~'~ 2 <br /> 201ampa to 400 amps -- x $55.00=$ 2 <br /> 44~l amgs to 600 amps -- x $110fl0=$ 2 <br /> <br /> a) The fee for branch e~rcuits with the <br /> <br /> b) The foe fo~ branch circuits ~thout the <br /> <br /> TOTAL $ -- <br /> <br />S. FEES <br /> Al. Enter total of fees from Sec. g4 $ <br /> A2. Add State Surcharge (.0~% x A 1 ) ~,D-/ $ <br /> <br /> SUBTOTAL $ <br /> <br /> B. Enter 30% of line A1 for Plan Review <br /> C. Investigation Fee (if requLn~d) $ <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 /> O. Inspection Oulsifle Normal Business Heats, <br /> ($62.50/hr, minimum two hour) · <br /> H. Industrial Plant ($62.50/hr) <br /> TOTALI~MOUNT~/~ DUE $ ~'~' <br /> <br />MC 15-34 Rev 9D8 <br /> <br /> <br />