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FOR CITY USE ONLY Received By: .Date: Zoning By: City: 1. LOCATION OF INSTALLATION Parcel ID: Site Add.ss: ~ City: _ · Zip: Cross Street/Direcfious'~ Project Description: pERd41TS ARE NON. TRA3ISFERABLE AND EXPIRE IF WORK IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE OR IF ' WORE IS SUSPENDED FOR 180 DAYS. lA. CONTRACTOR INFORMATION co~tract~ S,:~rclNo.: ~ Contracto~ License No..' . Sul~visor Liceuse No.: ~. ~ Signam~ of Supmvislng Elecuicia~. d ~a~ ~ldjl~ FOR OWNER INSTALLATION Property Ownec. (p/ease pr/nO Mailing Ad~-',~s: City: State: Zip: I am the PROPERTY OWNER and own, reside in, or will reside in the completed structure and will be my own general contractor. 1 'understand tiuat I mu,vt register as a con~tructon contractor if the structure is sqld or offered for sale before or upon compledo~ If l hire subcontractors, I will hire only subcontractors registered with the Construction Contractors BoamL If l change my mind and do hire a general contractor who is registered with the Constructon Contractors Boar~ I will immediately ~atify Marion County of the name of the contractor, 3. PLAN REVIEW SECTION Marion County does not reqnire a plan ~view. We will provide plan review service if you complete Section 5B and submit two (2) sets of[ plans aud specifications with this application. MC ~$-34 Rev MARION COUNTY BUILDING INSPECTION 3150 Lancaster Dr. NE - Suite C Salem, Oregon 97305 8:00am - 4:30pm 24 HR Inspection Line 373-4427 FAX 588-7948 4. FEE SCHEDULE (complete and enter total in Al) Number of Inspections per permit allowed -- Unit ,%rvie~ Items Cost (each) S am 1000sq. fLcfless -- x $110.00=$__4 EachadditionalS00~q. ft. orportinnthereof -- x :$20.00=$__ LimRed Energy -- x $30.00 = $ -- I Modala~ Dwelling Servic~ or Feeder __ x $52.00 = $__ 2 B. S~r~te~ or F~de~ CDo~ no~ Include branch Circuits, ~ s~tion D) l~stalinflon, Alteration or R~loeaflon 200 amps et lesa -- x $65.00=$__2 201ampsto400amps -- x $80.00=$___2 401 amps to 600 amps -- x $130.00--$__2 601 ampsto 1000amps -- x $170.00=$___2 Over 1000 amt~ or volts -- x $390.00 = $ --- 2 Reconnect Only -- x $55.00=$___2 200 amps or lcas __ x $45.00--$__2 201an~ to 400 amps __ x $5~.00=$__2 401 amp~ to 600 amps -- x $110.00 =$__2 N~w, Alteration, or E.xten.~n Per Panel a) The fe~ for branch circalts with the Each braach circuit -- x $3.00 = $__ b) The fee for branch circuits ~out &e Flrat bxanch circuit ~----- x $50.00 = $ _~® Each additional branch circuit __ x $3.00 -- $ -- Each pump or h~igatlon circle -- x $55.00 = $ -- 2 Each Sign ~r Outllna Lighting -- x $35.00 = $ -- 2 Signal Ciremi(s) or a Limited Energy Panel, ~fion or Extension -- x $55.00 -- $ -- 2 E Each additinanl Inspee~n above, I~r ~ -- x $50.00 = $ --- G. Minor Immllalin~ Labe, h Packofl01abels@$10.00each __ x $100.00=$__ (~nld only Io El~c~ical Contractor) lt. Industrial Plant __ x $6ZS0/hr = $ -- Onetr~oFamllyl)wril~gF~:Sq. Feet -- x $ .09=$__ Dwelling Permit Labels (For Single Family Dwellings Only) OTI~R, as r~qui~nt by the Building Oflldnl $ -- TOTAL $ 5. FEES Al. Enter total of fees from See. A2. Add State Surcharge 605% x A1 SUBTOTAL B. Enter 30% of line A1 for Plan Review C. Investigation Fee (ff required) D. Relnspection ~ ($50.00) E. Additional Plan Review ($62.50/hr, minimum one-half hour) F. Inspection for which no fee is specifically indicated, ($62.50/hr, minimum one hour) G, Inspection Outside Normal Business Hours. ($62.50/hr, minimum two hours) H. Industrial Plant ($62.50/hr) TOTAL AMOUNT DUE $ $ $ $ $__