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Receivod~y: .Dale: Zoning By: City: Re,lot e Amount: $ I ELECTRICAL PERMIT APPLICATION Please complete all Sections, 1 through 5 · LOCATION OF INSTALLATION parcel ID: ci : [PEI~IITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE OR IF WORK IS SUSPENDED FOR ISO DAYS. 2A. CONTRACTOR INFORMATION Ci~,:C,~,,.o~,.! s~: 0 ~ zip: c~-t o ~ ~ C~B,~rd~o.: '~..~ 0 '~ ~ Co.m~U~seNo.: ~'~.--X t~_ C__ Supervisor License No.: ~t~ ~ ''~ ~ sig~t~ of S,~pe~i,i.g £J~i~i~.: ~ ~ .0.-~ 2IL FOR OWNER INSTALLATION Property Owner:. (please print) Mailing Addr~s: City: State: Zip: MARION COUNTY BUILDING INSPECTION 3150 Lancaster Dr. NE - Suite C Salem, Oregon 97305 ,~ d.Pa~)0am - 4:30pm 24 HR Inspection Line 373-4427 FAX 588-7948 I~dlLF, -~ INSPE nmr~i~o.,a soo ~... or ~o~ao. u~o~ ~ s~0.00 = $ Limited Energy -- x $30.OO = $ t Each Manufactured Home or Modular Dwelling Seawiee or Feeder -- x $52.00 = $ 2 B. $ers4ee~ or F~le~ (l~ns not include branch Clrcutis, ~e Installation, Alteration or Relocation 200 amps or less [ x $65.00 = $ ~5.~ 2 201 amps to 400 amps -- x $80.00 = $ 2 401amps to 600 aml~ __ x $130.00=$ 2 6~1 amps ~ t000 am~ __ x $170.00 = $ .__2 Owr l~00 amps or volts __ x $~90.00=$.__2 P~conncct Only -- x $55.00 = $__ 2 C, Temporary ServLees/Feoders lm~lhflm~ .M~.'-'all~as, ~r Relecotion 2ooampsorless -- x $45.oo=$__2 201amps to 400 amps -- x $55.oo=$__2 401amps to 600 ~nps -- x $110.00=$__2 Over 600 amps or IOOO volts s~ "B" above D. Brmw. h Circuits a) The fee for branch circuits with thc Each branch circuit -- x $3.00 = $__ b) Tbe fe~ fo~ branch circus without the First branch circuit x $50.00 = $. ~agh addi~onal bl~nch circuit E. Mis~llam~us (Ser*iee or Feeder Not lanlndod) ~ach pump or in4gation circle x $$5.00 = $ .-- 2 Each$ignorOctlineLighfing __ x $55.00=$.__.2 Signal Circuit(s) or a Limited Energy Panel. Alteration or Extension __ x $55.00 = $ .-- 2 F. Each is0~l~aal Inspection over the allowable In any of the above, per ~on -- x $50.00 = $ G. Minor Installation Labnls Pack of 10 labels ~$10.OO each (Solti only to Elecuicad Contractors) H. IndutanlalPlant -- x$62.50&r =$ Oaatr,~Fanalyl~nll~F~:Sq. Fect __ x $ .09=$ nwnl~s Permit Labets (For sinzte Fanmy ~wnlltn~s Only) O'nfl~R, as required by the ButMing Of~181 $ -- TOTAL $ I am the PROPERTY OWNER and own, reside in. or will reside in the compkted stracmre and wi~J be my own general contractor. 1 understand that I mu~t register as a construction contractor if the structure is soM or offered for sate before or upon comsoletio~ If I 'hire subcontractors, I will him only subcontractors registered witll the Construction Contractors Board. If I change my mind and do hire a general contractor who is registered with the Cor~truction Contractors Board I will immediately notO~ Marion County of tht name of ~e contractor. Owner*s Signature: 3, PLaN ~E¥'IEW SECTION IMarion County does not requin~ a plan review. We will provid~ plan review service if you complete Section 5B and submit two (2) set~ of pllms and specifications with this application. $. FEES At. Enter ~ of t~s from See. #4 A2. Add State Surcharge (.05% x Al) SUBTOTAL B. Enter 30% of line A1 for Plan Review C, Investigation Fee (if required) D. Reinspecfion Fee ($50.00) E. Additional Plan Review ($62.50/hr, minimum one-lmlf hour) E Inspe~ion for which no f~e is specifically indicated, ($62.50/hr, minimum one hour) G. Inspeclion Outside Normal Business Hours, ($62.50/hr, minimum two hours) H. Indaswisl Plant ($62.50/hr) TOTAL AMOUNT DUE MC 15-34 Rev 9/98