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] F~. I~l.:rs'~ USE ONLY ° ~ ~.e~eived B.~: · n Date: I ~eipt ~: I ~nt: $. ELECTRICAL PERMIT APPLICATION Please complete all Sections, I through $ I ~ 1. LOCATION OF INSTALLATION ~.~ ~'~ I~O Ci'ossStreet/Directions: A0"~-~dO~q qt~E Projeot DasCfil~on: ~t:[W~lj~ PERMITS ARE NON. TRANSFERABLE AND EXPIRE IF WORK IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE OR IF WORK IS SUSPENDED FOR 180 DAYS. 2A. CONTRACTOR INFORMATION Contractor: Mai~thg Address: City: State: Zip: Phone: Pax: Contractors Board No.: Contractor Li~nse Supervisor L/lcensc No.: Signature of Supervising Electocian: 2B, FOR OWNER INSTALLATION Property Owner: (please pnnt) Mailing Address: ~C) ~ ~ tZ ci~: fiX~oWA s~te: O~ zi~: I am the PROPERTY OWNER and own, reside in, or will reside in the completed structure and will he my own general contractor. 1 understand that I 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 genend contractor who is registered with the Construction Contn~ctors Board, I will immediately not(fy Marion 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 pinna and specificalions 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 Line 373-4427 FAX 588-7948 4. FEE SCHEDULE (complete and enter total in Al) Number of Inspections per permit allowe~ -- Items Cost (each) Sum 1000sq. fl. orlcas -- x $110.00=$__4 Each additional 500 sq. fl. or po~on thereof -- x $20.00 = $__ Limited Energy -- x $30.00 = $__ 1 Each Manufactured Home or Moduia~ Dwelllng Service or Feeder -- x $52.00=$__2 B. Services or Feeders (Does not Include brauch Circuits, see section D) I=l~llaflon, Alter~lion or Rdoe. alioo I 200 amps or less -- x . 201amps to 400 amps -- x $80.00=$__2 401 amps to 600 amps -- x $130.00=$__2 601 ampsto 1000amps __ x $170.00=$__2 Over 1000 amps or volts -- x $390.00 =$__2 Reconnect Only -- x $55.00=$__2 Installation, AItsratinns, or Relocation 200 amps or lcss -- x $45.00=$__2 20I amps to 4OO amps -- x $55.00=$__2 401 amps to 600 amps -- x $110.00=$__2 Over 600 amps or 1000 volts see "B" above New, Alteration, or Extemion Per Panel a) The fee for branch circuits with the ~ach I~'anch circuit x $3.00--$ ~ additional I~'anch cbouit -- x $3.00 = $__ E. Mlscelteneom (Service or Feeder Not Included) Each pump or hxigatlon circle -- x $55.00 = $ 2 Each Sign or Outline Lighting -- x $55.00 = $ -- 2 Signal Cbouit(s) of a Limited Energy Panel, Alteration c~ Extension -- x $55.00 = $__ 2 F. Each additional Inspection over the allowable in any of the above, per inspection -- x $50.00 = $__ G. Minor Instui~tion Labels Pack of 10 labels @$10.00 each -- x $100.00 = $ -- (Sold only to Elec~cal Contractors) H. Industrial Plant __ x $62.501hr = $__ OnetTwopemllyDwdl~gFe~:Sq. Feet -- x $ .09=$ Dw~ling Permit Labels (For Single Family Dwellings Only) NIC OTHER, as required by the Building Oi~cinl $ -- 5. FEES Al. Enter total 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 required) D. Reinspection Fee ($50.00) E. Additional Plan Review ($62.50/hr, minimum one-half hour) F. Inspection for which no fee is specifianliy indicated, ($62.50/hr, minimum one hour) (3. Inspection Outside Normal Business Hours, ($62_50hir, minimum two hours) H. Indusffial Plant ($62.50/hr) TOTAL AMOUNT DUE $ $