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i ' Electrical Permit Application PLAN REVIEW �_': Marion County Public Works Please check all that apply: ❑ Service or feeder at 600 amps or over Marion 5155 Silverton Rd NE,Salem,Oregon 97305 ❑ Service or feeder 400amps 0 Building over three stories • County Phone:(503)588-5147 Fax: (503)588-7948 or more where the available fault El Marinas and boatyards current exceeds 10,000 amps at ❑ Floating buildings o R E C O N Email: Building(;ico.marion.or.us 150 volts or less to ground,or ❑ Commercial-use agricultural Internet address: www.co.marion.or.us exceeds 14,000 amps for all other buildings installations ❑ Installation of 150 KVA or larger 0 Fire pump separately derived system CATEGORY OF CONSTRUCTION ❑ Emergency system ❑ "A,""E,""1-2,"1-3"occupancy ❑ Residential Q Addition of new motor 0 Recreational vehicle parks ❑ Government ❑■ Commercial load of 100HP or more 0 Health-care facilities JOB SITE INFORMATION AND LOCATION El Six or more residential units El Hazardous locations Job site address:2895 Progress Way FEE SCHEDULE City/state/zip:Woodburn, OR 97071 Description Qty. Fee Total Suite/Bldg/apt no.: Project name: Residential single-or-multifamily dwelling unit. Includes attached garage. Business Name,if applicable:UniverSal Forest Products 1,000 sq.ft.or less $139.75 4 Subdivision: Lot no: Ea.Add'l 500 sq ft or portion $26.00 DESCRIPTION OF WORK Limited energy,residential (with above sq ft) _ $67.25 2_ Master Permit Each manufactured or modular dwelling, service,and/or feeder , $67.25 2 • Services or feeders installation,alteration,and/or relocation PROPERTY OWNER INFORMATON 200 amps or less $82.75 2 Name: 201 amps to 400 amps $98.25 2 Mailing Address: 401 amps to 600 amps $163.50 2 City/State/ZIP: 601 amps to 1,000 amps $212.00 2 Phone: Fax: Over 1,000 amps or volts $491.50 2 • Email: Reconnect only $67.25 1 Temporary services or feeders installation,alteration,and/or relocation Owner'Installation:This installation is being made on residential or farm 200 amps or less $67.25 2 property owned by me or a member of my immediate family.This property is not intended for sale,exchange,lease,or rent.ORS 479.540(1)and 201 amps to 400 amps $89.00 2 479.560(1). 401 amps to 599 amps $129.50 2 Signature: Date: Over 600 amps or 1,000 volts,see services or feeders section above Branch circuits—new,alteration,or extension,per panel CCB form is required for homeowner installations Click for CCB Form A.Fee for branch circuits with above service or feeder fee,each branch circuit $5.50 2 B.Fee for branch circuits without CONTRACTOR INFORMATION service or feeder fee,first branch circuit $67.25 2 Business name: Creation Electric, Inc. Each add'l branch circuit $5.50 Contact name: Elson Strubhar ____ Miscellaneous(service or feeder not included) Address: 18360 Fobert Rd NE Pump or irrigation circle $67.25 2 City/State/ZIP: Hubbard, OR 97032 _ �! Sign or outline lighting $67.25 2 Phone: 503.209.0680 Fax: 503.981.5495 Signal circuit(s)or limited energy panel, $67.25 2 alteration,or extension,Describe: E-mail: creation@afo.net Hourly rate(no.of hrs.x fee per hour) $67.25 CCB License no: 133768 _Electrical Lic: 24-405C Supervising Electrician Lic no: 4324S Master Permit $67.25 67.25 Each additional inspection over allowable in an of the above Print name of Elson Strubhar signing supervisor: Per inspection $52.00 Signature of kx n � Investigation fee,if applicable signing supervisor: ��-• ELECTRICAL PERMIT FEES This permit application expires if a permit is not obtained within 180 days after it has (A)Enter subtotal of above fees $ 67.25 •been accepted as complete. 1.For owner installations,owner must be . r•�; ! 'Th (B) Enter 12%State of Oregon Surcharge(0.12 x[A]) $ 8.07 corporation,LLC,or trust—OAR 918-261 :I. V � � (C) Plan review,if required(0.25 x[A]) $ GAFORMSTLEC E•01 Word Application.doc JAN N 13 2021 TOTAL fees and surcharges(A through C) $ 75.32, Rev aizola 'Number of inspections allowed per permit. (l17 City of Received by: Date: MARION COUNTY BUILDING INSPECTION 21 -0(23U5 3 S`I