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FOR CITY USE ONLY Received By: Date: Zoning By: City: Receipt #: Amount: $ I ELECTRICAL PERMIT APPLICATION Please complete all Sections, I through $ 1. LOCATION OF INSTALLATION Parcel ID: Site Address: Zip: C Cro~s S~eet/Directions: ^ / l~l ~ i ~, ,/~l MARION COUNTY BUILDING INSPECTION ~.,.ff/,~ [ t ~ I[fl' L,, ~ ,, , 3150 Lancaster Dr. NE - Suite C IIllJl.:~.~dYil,~l IV/~'~* Salem, Oregon 97305 g~i ~.~,~"~ ~0~ .~/ 24 HR Impection Luic 373-4427 FAX 588-7948 .._ ~ ~l~E g~i~DULE (complete and enter ~ in Al) "'0~V C~ ',,r,i~V~.~Re~idetuinl Per Unit S~r~naTe:s PerxCI~o~l(;;w~ Sum 4 BIllLOINQ INsf fffl031~ooo sq. ft. Each additional 500 sq. ftc. or portion thereof -- x $20.00 Limited Enemy __ x $30.00 = $ -- 1 Each Manufactured Home or MedalarDwellingSe~vieeorFeede~ -- x $52.00=$__2 B. Ser~ces or Feeders (Does ~ot inchide Im~llotion, AReralion or Relocation 200an~zorless __ x $~.00=$__2 201amps ~o 400 amps -- x $~0.00=$__2 401 amps to 600 amps x $130.00 = $ -- 2 601 ampstu 1000amps -- x $170.00 =$__2 Over 1000 amps or volte -- x $3~0.00 = $ -- 2 Reconnect Only -- x $55.00 = $ -- 2 Insthllatlon, AReralions, or Relocation 201ara~ to 40O amps -- x $55.00=$__.2 401 aml~ to ~00 amps -- x $110.00 = $ __.2 Owr 600 amps or 1000 volts ~ee "B" above D. Br~n~h Circuits New, AReraflon, or Extsm~n Per P~mel a) ~he fee for branch circuite with the n~rchz~e of Service c~ Feeder Fee: Each branch circuit __ x $3.00 = $ b) Tbe fee f~ branch circ~ts withont ~be ~rch~e of Se~ice or Feeder Fee: First branch circuit -- x $50.00 -- $ -- Each addi~onal branch circuit x $3.00 -- $ -- E. Mlscelloaeo~ (S~rvl~e or Feeder Not lnclmled) Each p~mp or irdgnQon circle Each Sign or Outline Lighting Signal C~rcuit(s) or a Limited Energy Panel, Alteration or Extension F. Each additional lmpe~flon over the allowable in any of the abov~,perinsg~toa -- x $50.00=$__ G. Minor Inst~latton Labds Pack of 10 labels @$10.00 each -- x $100.00 = $__ (Sold only to Elecuical Contractors) IL Industrial Plaat -- x $62~fnr = $ -- Oa~TwoF~a~lyDvntl~gF~e:Sq. Feet -- x $ .09=$__ Dvntl~g Permit Labels ~or ~ Family Dwellings Only) N/C OTHER, as ~ by the Building Offi@nl $ __ TOTAL $ -- IPERMITS ARE NON. TRANSFERABLE AND EXPIRE IF WORK IS NOT STARTED WITHIN 1~0 DAYS OF ISSUANCE OR IF WORK IS SUSPENDED FOR 180 DAYS. 2A. CONTRACTOR INFORMATION Contractor: Mailing Address: City: State: Zip: Con.actor License No.: Prove~y Owner: (pleose print) Mailing Address: City: State: Zip: 1 amthe PROPERTY OWNER and own, reside in, or will reside in the completed structure and will be my own general contractor. I understand that I must register as a construction contractor if tbe structure is sold or offered for sale before or upon completiot[ lf l hire subcontractors, I will hire only subcontractors registered with the Construction Contractors Board. If I change my mind and do hire a general contractor who is registered with the Construction Contractors Boar& I will immediately notify Ma~on County of the name of the contractor. Owner's Signature: 3. PLAN REVIEW SECTION 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. x $55,00 = $__2 -- x $55.00=$__2 5. FEES Al. Enter total of fees from Sec. g4 A2. Add State Surcharge (.05% x Al) SUBTOTAL B. Enter 30% of linc A1 for Plan Review C. Invesdgolion Fee (if required) D. Rcinspection Fee ($50.00) E. Additional Plan Review ($62.50/hr, minimum one-haif hour) F. Inspection for which no fee is specifically indicated, ($62.50/hr, minimum one hour) G. Inspection Outside Normal Business Hours, ($62.50thr, minimum two hours) H. Indusu-ial Plant ($62.50/hr) TOTAL AMOUNT DUE $ Z~_'~ $__ MC 15-34 Rev 9/98