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FOR CITY USE ONLY Received By: Date: Zoning By: Ci~: Receipt ~. Amount: $ ELECTRICAL PERMIT APPLICATION Please complete all Sections, 1 through 5 1. LOCATION OF INSTALI~TION Parcel ID: Oily: ' z p: 95'0o'z. Cross SLn~t/Direetions: WOI~Y IS SUSPENDED FOR 180 DAYS. 2A. CONTRACTOR INFORMATION Mailing Address: City: State: Zip: Phone: ~o~wactors Board No.: Con~-actor License No.: Supervisor License No.: Signatur~ of Supervising Elec~¢ian: 213. FOR OWNER INSTALLATION ci,y: IO t .A 6C zip: tOooZ I am the PROPERTY OWNER and own, reside in, or wilt reside in the completed structure and will be my own general contractor. I understand that l must register as a construction contractor if the structure is sold or offered for sale before or upon completion, lf l hire subcontractors, I will hire only subcontractors registered with the Construction Contractors Boar& If I change my mind and do hire a general contractor who is registered with the Construction Contractors Boara~ 1 will immediately no~'fy Matqon [~ounty of the Marion County does not require a plan review. We will provide plan review service if you complete Section 5B and submit two (2) sets of plans and specifications with this application. MC 15-34 Rev 9/98 MARION COUNTY BUILDING INSPECTION 3150 Lancaster Dr. NE - Suite C Salem, Oregon 97305 8:00am - 4:30pm 24 HR Inspection l~ne 373-4427 FAX 588-7948 4. FEE SCHEDULE (c~aplet~ and ent~r total ia Al) Number of Inspections per permit allowed A. Re~den~ad Per Unit Servl~e Included: 1000 sq. fL or l~ss Each additional 500 sq. ft. or portion th~eof -- Limited Energy Each Manufactured Home or Modular Dwelling Set,ce ~ Feeder Items Cost (each) Sum -- x $110.00=$__4 x $20.00 = $__ __ x $30.00=$__1 -- x $52.00=$__2 B. Services or Feeders (Does not Include branch Circuits, see section D) Installation, Alteration or Relocation 200 amps or leSS ~ps~t~ ~ x $65,00=$ ~,~'92 201amps to 400 -- x $80,00=$__2 401 amps to 600 amps __ x $130.00 = $ 2 601amps to l000 amps -- x $170.00=$ 2 Over 1000 amps or volts -- x $390.00 = $ 2 R~conmmt Only __ x $55.00 = $ 2 200 amps or less -- x $45.00--$__2 201amps to 400 amps -- x $55.00=$__2 401amps to 600 amps __ x $110.00=$ 2 Owr 600 ampa or 1000 volts ~ "B' above a) Th~ £ee for branch circuits with the Each branch ci~ait -- x $3.00 = $ b) The fee for branch circuits withom the $. FEES Al. Enter total of fees from Sec. g~. A2. Add State Surcharge (.05% x Al) SUBTOTAL B. Enter 30% of line A1 fur Plan Review C. Investigation Fee (if required) D. Reinspeetion Fee ($50.00) E. Additional Plan Review ($62.50/hr, minimum oee-half hour) F. Inspection for which no fee is spealfically indicated, ($62.50/hr, minimum one hour) G. Inspection Outside Normal Business Hours, ($62~0/hr, minimum two hours) H. Indas1~'ial Plant ($62.50/hr) TOTAL AMOUNT DUE $ ~.~5 $__ $__ $__