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FOR CITY USE ONLY R~:~iv~ By; Date: Zoning By: City: R~-ipt #: , A.m~m: $ ELECTRICAL PERMIT APPLICATION Please complete all Sec~ons, I through 5 LOCATION OF INSTALLA. TION c ,y: /40'4, Phone: CONWCTOR OUmTION Fax: Ptoper~ Owner: (please prinO Mailmg Addr~s: State: Zip: I am the PROPERTT 0 WNER and own. reside in, or will reside in the completed structure and w#l be my own general contractor. I understand that I must register as a construction contractor if the structure 15 sold or offered for sale before or upon completion. If~ here subcontractors. I will hire only subcontractors registered with the Construction Contractors Board. If l change my mind nod do hire a general contractor who is regzstered with the Conatructian Contractors Board. I well immediately notif~ Marion County of the name of the contractor: Marion County doc~ not rcqui~c a plan rcviea~, Wc will provide ptan review sect ice if you e. omplotc Section 5B and submit two (2) Salem, Oregon 97305 8:00 am - 4:30 pm 24 hr. I~n Line 3734427 FAX 585-7948 4. FEE SCHEDULE Icomplete and enter total in AlI Number of ln~ectinns p~ pc~int allowed-- A. Residential Per Unit, Service Included Item~ Cost (c~ch) Sum 1000 St. Ft. or I~ss x $110.00 =$ 4 Each Additional 50~ Sq. FI. or portion thereof x $20.00 =$ Limited Energy x $ 30.00 = $ 1 Ea Manufactured Hom~ or Modu[~ Dwelling Sea-¥ice or Feeder -- x $ 52.00 = $_~._2 IL Services or Fecder~ (Do~s not include branch Circuits, see Section D) Installation, Alteration, or Relocation 200 amos or I~s x $ 65.00 = $ 2 201 ampsw4OOamps x $80.00 = $ 2 401 amps to 600 amps x $130.00= $ 2 601 amp~ to 1000 amps x $170.00= $ 2 Ova' 1000 amps or volts x S390.00 = $ 2 ReconneclOnly x $ 55.00= S 2 C. Temporary Services/Feeders Installation, Alterationss or Relocation 200nmpsorlcas x $45.00 = $ 2 201 m~peto400amps x $55.00 = $__2 401 nmpsto600 amps x $110.00= $__2 Over 600 amp~ or 1000 volts, see "B' above D. Branch Circuits New, Alteration, or Extension Per Panel a) ~ f~ for branch circuits with the ourchase ofServiceorFeederFee. EaBrCir x $ 3.00 = $ b) The fee fo~ branch circuits without the marehase of Service or Feeder Fee: FirslBranchCitcuit x $50.00 = $ EachAdditionalBraachCireuil x $ 3.00 = E. Mbeetianeous (Service or Feeder Not Included) Ea~pomporinign6~circle x $55.00 = $ 2 Each Sign or Outline Lighting x $ 55.00 = $ 2 Signal Circuit(s) o~ a Limited Energy Panel, Alteration, or Extension x $ 55.00 = $ 2 F. Each Additional inspection, aver the allaveable ia mn}' of the above, per inspection x $ 50.00 = $ -- G. Minor Installation Labels Pack of 10 lahels ® $10.00 each x $100.00~ $ (Sold only to Electrical Conttaclors) H. [gdnstrial Plant x $62.50 / hr = $ On,Two Fmmily Dwelling Fee: Sq. Feet x $ .09 = $ Dwelling Permit Labels (For Single Family D~lling~ Only) OTHER, as required by the Building Offi¢ial $ TOTAL $ 5. FEES Al. Enter Total Fees fi'om Section #4 A2 Add State Surcharge (.05% x Al) $ SUBTOTAL: $ $ B. Enter 30% of line Al for Plan Review $ C. Investigation Fee, ifrequ'tred $ __ D. Reinspection Fee ($50.00) $ __ E. Additional Plan Review (62.50/bx, minimum one-half hour) $ __ E Inspection for which no fee is specific, ally indicated, ($62.50/~tr, tffmimum one hour) $ __ G. Inspection Outside Normal Business Hours, $62.50/hr, minimum two hours) $ __ H. Industrial Plant ($62.50/hour) TOTAL AMOUNT DUE $ MC 15-34 Rev 9ff)8