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Electrical Permit Application PLAN REVIEW Marion County Publ' S r5 [iv heck all that apply: (] Service or feeder at 600 amps or over Marion 5155 Silverton Rd NE,Sal: 1 ii.. S ice or feeder 400amps ❑ Building over three stories County r v �" or ore where the available fault ❑ Marinas and boatyards Phone: (503)588-5147 F. 588-7948 nt exceeds 10,000 amps at Floating buildings o R e e o N Email:Build re co.mario �� 0 volts or less to ground,or El Commercial-use agricultural Internet address: www.co.marion.D.CST 2 8 2020 exceeds 14,000 amps for all other buildings y�' COON nstallations CI Installation of 150 KVA or larger MARION COON T�FupAe�oump separately derived system CATEGORY OF CONSTRUC'M, IlING INSPEC taakgency system ❑ "A,""E,""I-2,""I-3"occupancy El Residential l] Addition of new motor El Recreational vehicle parks ❑ Government ❑■ Commercial load of 100HP or more ❑ Health-care facilities JOB SITE INFORMATION AND LOCATION ❑ Six or more residential units ❑ Hazardous locations Job site address:2700 E Santiam Street FEE SCHEDULE * City/State/Zip:Stayton,OR 97383 Description Qty. Fee Total Suite/Bldg/apt no.: Project name: Geren Island WTP SECW Residential single-or-multifamily dwelling unit. Includes attached garage. Business Name,if applicable:City of Salem 1,000 sq.ft.or less N/A $139.75 4 Subdivision: Lot no: Ea.Add'] 500 sq ft or portion $26.00 DESCRIPTION OF WORK Limhedve residential (with above sq ft) $67.25 2 New electrical building for the Southeast Collector Well, 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 1 $82.75 $82.75 2 Name:Keith Kuenzi,City of Salem Public Works 201 amps to 400 amps $98.25 2 Mailing Address:555 Liberty Street,SE-Room 325 401 amps to 600 amps 1 $163.50 $163.50 2 City/State/ZIP:Salem,OR 97301 601 amps to 1,000 amps $212.00 2 Phone:503-588-6211 Fax: Over 1,000 amps or volts $491.50 2 Email:KHKUENZI@cityofsalem.rnet Reconnect only $67.25 1 Temporary services or feeders installation,alteration,and/or relocation Property Owner'Installation:This installation is being made on residential or farm property owned by me or a member of my immediate family.This 200 amps or less $67.25 2 property is not intended for sale,exchange,lease,or rent.ORS 479.540(1) 201 amps to 400 amps $89.00 2 and 479.560(1). 401 amps to 599 amps $129.50 2 Signatur Date:Yal/f/7,__„ Over 600 amps or 1,000 volts,see services or feeders section above Branch circuits-new,alteration,or extension,per panel A.Fee for branch circuits with above CCB form is required for property owner installations Click Here service or feeder fee,each branch circuit 10 $5.50 $55.00 2 B.Fee for branch circuits without CONTRACTOR INFORMATION service or feeder fee,first branch circuit $67.25 2 Business name: Each add'l branch circuit $5.50 Contact name: Miscellaneous(service or feeder not included) 3 $201.75 Address: Pump or irrigation circle $67.25 2 City/State/ZIP: Sign or outline lighting $67.25 2 Phone: Fax: Signal circuit(s)or limited energy panel, $67.25 2 alteration,or extension,Describe: E-mail: Hourly rate(no.of hrs.x fee per hour) $67.25 CCB License no: Electrical Lic: Master Permit $67.25 Supervising Electrician Lic no: Print name of Each additional inspection over allowable in any of the above signing supervisor: Per inspection l $52.00 Signature of 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 503.00 been accepted as complete. (A)Enter subtotal of above fees $ (B) Enter 12%State of Oregon Surcharge(0.12 x[A]) $60.36 1.For property owner installations,owner must be a natural person,cannot be a corporation,LLC,or trust-OAR 918-261-0040. (C) Plan review,if required(0.25 x[Al) $125.75 G\FORMS\ELEC\E-01 Word Application.doc TOTAL fees and surcharges(A through C) $689.11 Rev 6/2020 *Number of inspections allowed per permit. City of Received by: Date: