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FOR CrYY USE~)NLY Received By: .Date: Zoning By: City: Receipt #: Amount: ELECTRICAL PERMIT APPLICATION Please complete all Sections, 1 through 5 1. LOCATION OF INSTALLATION PERMITS ARE NON.TRANSFERABLE AND EXPIRE IF WORK J IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE OR IF WORK IS SUSPENDED FOR 180 DAYS. A. CONTRACTOR INFORMATION Con taor:f ?Off 2B. FOR OWNER INSTALLATION Property Owner: (please print) Mailing Add. ss: City: Stale: Zip: I am the 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 the structure is sold or offered for sale before or upon completion. If 1 hire subcontractors, I will hire only subcontractor~ registered with the Construction Contractors Board. If l change my mind and do hire a general contractor who is registered with the Construction Contractors Board, l will immediately notify Marion County of the name of the contractor Owner's Signature: PLAN REVIEW SECTION Marion County does not require a plan review. We will provide plan I MC 15-34Rev 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 allowed -- A. Residential Per Unit Service Included: Items Cost (each) Sum 1000sq. ft. orloss -- x $110,00=$ 4 Each additional 500 sq. fl. or portion thoreof -- x $20.00 = $ -- Limited Energy -- x $30.00 = $ -- 1 Each Manufactured Home or Modular Dwelling Servi¢~ or Feeder -- x $52.00=$__.2 Services or Feeders (Does not include branch Circuits, see section D) Installation, Alteration or Rcloe~tlon 200 amps or less '7~- x $~.00:$ 13 0 2 201amps to 400 amps -- x $80.00=$ 2 401 amps to 600 amps -- x $130.00 = $ 2 601 amps to I000 amps -- x $170.00 = $_ Over 1000 amps or volts -- x $390.00 = $ -- 2 Reconnect Only -- x $55.110 = $ -- 2 C. Temporary Services/Feeders lnstalintion~ Aliorations, or Relocation 200 amps or less -- x $45.00=$__2 201amps to 400 amps -- x $55.00=$__2 401 ampsto600amps -- x $110.00=$__2 Over 600 amps or 1000 volts see "B" above D. Branch Circuits New, Alteration, or Extension Per Panel a) The fee for branch circuits with the Each branch circuit -- x $3.00 = $ -- b) Tile fee for branch circuits without the warcha.~e ~f ge~wice er Fee, der First branch circuit -- x $50.00 = $ -- Each additional branch circuit -- x E. Miscellaneous (Sertic~ or Feeder Not Included) Each pump or irrigation circle -- x $55.00 = $ -- 2 Each Sign or Outline Lighting -- x $55.00 = $ -- 2 Signal Circuit(s) or a Limited Energy Pan~l, Alteration or Exlension -- x $35.00 = $ -- 2 E Each additional Inspection over the allowable in any of the above, per inspecllon -- x $50.00 = $ -- G. Minor Installation Labels Pack of 10 inbcls ¢$10.00 each -- x $100.00 -- $ ~ (Sold only to Electrical Contractors) H. Industrial plant -- x $62.50&r = $ -- One/rwoFamllyDwelllngFee:Sq. Feet -- x $ .09=$__ Dwelling Permit Labels (For Single Family Dwellings Only) N/C OTHER, as required by the Building Official $ -- TOTAL $ 5. FEES A 1. Enter total of fe~s from Sec. g4 A2. Add State Surcharge (.05% x Al) SUBTOTAL B. Enter 30% of line Al for Plan Review C. Investigation Fee (if required) / D. R~inspection Fe~ ($50,00) E. Additional Plan Review ($62.50/hr, [ minimum one-half hour) F. Inspection for which no fee is specifically indlcat~nl,.....~ ($62.50/hr, minimum one hour) G,Inspection Outside Normal Business Hours, ($62.50/hr, minimum two hours) H. Industrial Plant ($6230/hr) TOTAL AMOUNT DUE