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FOR CITY USE ONLY <br />Receivrxl By: Date: <br />Zoning By: City: <br />Rece~ #: Amount: <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />LOCATION OF INSTALLATION <br /> <br />SileAddress: ~10~~'~ /t~x.%e..~' ~ ~ <br /> <br />IS NOT ST~ ~HIN 180 DA~ ~iSsU~CE OR IF <br />WO~ IS SUSPE~ F°R 180 DAYS. I <br /> <br />2A. CONTRACTOR INFORMATION <br /> <br />Maillag Address: <br /> <br />Phone: <br /> <br />State: Zip: <br /> <br />Contract. s Board No.: <br /> <br />2B. FOR OWNER INSTALLATION <br /> <br />MallingAddrc'~:~*0, gOX ~ I <br />City:~ ~ S~:0~ Zip~ ~ ~ <br /> <br />Iarn the PROPERTY OWNER and ow~ reside in, or will reside in <br />the completed structure and will be my own general contractor. I <br />understand that I rnttrt register as a construction contractor if the <br />structure is sold or offered for sale before or upon completiott If 1 <br />hire subcontractors, I will hire only subcontractors registered with <br />the Construction Contractors Board. If I change my mind and do <br />hire a general contractor who is registered with the Construction <br />Owner~a~era°cf't~cB°n°~trt~aclt°Wr'ills Signature: ~.rimmedialelY ~'~~~ Mtr ~ C~ un~ of the <br /> <br />3. PLAN REVIEW SECTION <br /> <br /> Marion County does no~ requir~ a plan review. We will provide plan <br /> review service if you complete Section 5B and submit two (2) sets of <br /> p aris and specifications w th this application. <br /> <br />MC 15-34 Rev 9/98 <br /> <br /> MARION COUNTY BUILDJNG INSPECTION <br /> 3150 Lancaster Dr. N~ - Suite C <br /> Salem, Oregon 97305 <br />8:00am - 4:30pm 24 HR Inspection Line 373~1427 FAX 588-7948 <br /> <br />4, FEE SCHEDULE (complete and enter total in Al) <br /> <br /> Numb~ of teap~tions p~r permit allowed -- <br />A. Residential Per Unit S~r*ic~ IneAuded: <br /> <br />Items Cost(each) Sum <br />-- x $110.00=$ 4 <br /> x $2~00= $ <br />__ x $30.00= <br /> <br />-- x $52.00=$ 2 <br /> <br />B. Services or Feeders (Does not Include branch Circuits, see s~ion D) <br /> toshdlation, Alteration or Relocation <br /> 200 amps or lena <br /> 20tampsto400amps __ x $80.00=$. 2 <br /> <br /> Sig~l Circe~s) or a l~mi~l Eee~S~ <br /> <br /> OTIIF~ ~s reqnin~l by the ~ull~ O~,ti <br /> <br />Al. Enter total of fees from Sec. g4 <br /> <br />A2. Add State Surcharge (.05% x Al) <br /> <br />SUBTOTAL <br /> <br />B. Enter 30% of line A 1 for Plan Review <br />C. Investigation Fee (if required) <br />D. Reinsl~cfion 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 /> ($62.50thr, minimum one hour) <br />G. Inspection Outside Normal Business Hours, <br /> ($62.50/hr, minimum two hours) <br />H, Industrial Plant ($62.50&r) <br /> <br />TOTAL AMOUNT DUE <br /> <br /> <br />