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iF OR CITY USE ONLY Received By: Date: Zoning By: City: Receipt ~: Amount: IELECTRICAL PERMIT APPLICATION I Please complete all Sections, I through $ I 1. LOCATION OF INSTALLATION *E~ITS A~ NON. T~SFE~ AND ~lRg IF ~ IS NOT S~ARTED W~HIN 180 DAYS OF ISSU~CE OR IF WO~ IS SUSPENDED FOR 180 DAYS. Property Owner: (please printl Mailing Address: City; State: Zip: I am the PROPERTY OWNER and own. reside in, or will reside in the completed structure and will he my own general contractor. I understand that I must register as a construction contractor if the structure is sold or offered for sale before or ~pon completlon, 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 Board, I will immediately notify Marion County of the name of the contractor Owner's Signature: ;. PLAN REVIEW SECTION MARION COUNTY BUILDI3IG 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 SCHEDULIE (~l~e~ and e~er total in Al) Marion County does not require a plan review. We will provide plan I review service if you complete Section 5B and submit Mo (2) sets Of ' plans and specifications w th th s app cation. MC 15-34 Rev 9~98 lt~n~ Cost (each) Sum x $110.00 = $ 4 x $20.00 = $ x $30.00 = $ I Services or Feeders (Does not Incl~de bnm~ Circnit~ ~e sacfloa D) Installation, Altera~on or Relocation 200 amps or less I x $65.00 = $ 201 amps to 400 amps x $80.00=$ 2 401 amps to 600 amps x $130.00 = $ 2 601 ampsto 1000 amps x $170.00 =$ Over 1000 amps or volts x $390.00 -- $ 2 R~connect Only x $55.00 = $ __ D. Branch CIrmlta New, Al~ratlon, or Extemlon Per Panel E Each additional Inspection Onarrwo Fandly Dwelting Fee: Sq. Fe~t Ol'ttzR, as required by the Building Official TOTAL $3.00 = $__ $50.00 = $ __ $3.00 = $ ~ $55.00 = $ 2 $55.00 = $ 2 $55.~0 = $ 2 n $50.00=$. x S100.00 = $ x $6230~r = $ x $ .09=$ 5. FEES Al. Enter tote[ of fees from Sec. #4 A2. Add State Surcharge (.05% x Al) SUBTOTAL B. Enter 30% of line A1 for Plan Review C. Investigation Fee (if zequired) D. Reinspeclion Fee ($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, ($62.50far, minimum two hours) $ __ H. Industrial Plant ($62.50/hr) $ __ TOTAL AMOUNT DUE $10~3' ~:9~ $ $ $__