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FOR CITY USE ONLY Re~ived By: Date: Zoning By: City: Receipt #: Away~nt: $__ i I ELECTRICAL PERMIT APPLICATION Please complete all Sections, 1 through $ 1. LOCATION OF INSTALLATION 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 Contr=tor Licens~ No.: "~f -- Supervisor License No.: ~ V Signature of Supervising Electrician: :lB. FOR OWNER I~$TALLATION Propen~y Owner: (please print) Mailing Adckess: City: State: Zip: I am the PROPERTY OWNER and own, reside in, or will reside in the completed structure and will be my own general contractor. ] understand that I must register as a construction contn~ctor if the structure is sold or offered for sale before or upon comple~ion, lf l hire subcontractors, I will hire only subcontractors registered with the Construction Contractors BoanL If l change my mind and do hire a general contractor who is registered with the Construction Contractors Board, I will immediately notify Marion County of the name of the contractor. Owner's Signature: Marion County docs not ~ review service if you corn plans and specifications w MC 15-34 Rev 9/98 3. PLAN REVIEW SECTION NOTICE EFFECTIVE 7-1-99 STATE SURCHARGE CHANGE FROM 5% TO 7% MARION COUNTY BUILDING INSPECTION / 3150 Lancaster Dr. NE - Suite C Salem, Oregon 97305 8:00am - 4:30pm 24 HR Inspection Line 373-4427 FAX 588-7948 4. FEE SCHEDULE (complete and enter total in Al) Items Cost (each) Sum ~ooo~q.a.o~l~ss ~ x SllO.OO=$ Each additional 500 sq. ft. or portion thereof -- x $20,00 = $ -- Limited Energy --. x $30.00 = $ -- 1 Each M~nufactm~l Home or Modular Dwelling Service or Feeder -- x $52.00 = $ -- 2 B. Services or Feeders (Does not include branch Circuits, see section D) Installation, Alteration or Relocation 200 amps or less --. x $65,00=$__2 201amp~ to 400 amps -- x $80.00=$ 401 amps to 600 amps -- x $130.00 = $ -- 2 61}1 ampsto 1000amps -- x $170.00 =$ 2 Over 1000 amps or volts -- x $390.00 = $ 2 Reconnect Only -- x $55.00 = $ 2 C+ Temlmrary Services/Feeders Installation, Alterations, or Relocation 200 amps o~ less -- x 545,00=$__2 201 amps to 400 amps x $5~,00 = $ 2 40~ amps to 600 amps -- x $110.00=$__2 Over 600 amps or 1000 volts se~ "B" above D. Branch Circuits New, Alteration, or Extension Per Panel a) Thc fcc for branch circuits With the vurchase of Service or Feeder Fee: Each branch circuit -- x $3.00 = $ -- b) Thc fee for branch circuiks without thc ourchase of Service or Feeder Fee: First branch circuit x $50,00 = $ -- Each additional branch circuit -- x $3.00 = $__ E. Mlscalinneous (Service or Feeder Not included) Bachpurnporinlgatinncircle -- x $55.00=$__2 Bach Sign or Outline Lighting -- x $55.00 = $ -- 2 Signal Circuit(s) or a Limitad Energy Panel, Alteration or Bxtension -- x $55.00 = $ -- 2 F. Each additional Inspection over the allowable in any of the above, per inspection -- x $50,00 = $ -- G. Minor InstaHuiion Labels pack of 10 labeIs @$10.00 each x $100.00 = $ -- (Sold only to Electrical Contractors) H. Industrial Plant -- x $62,50~hr = $ -- One/TwoFamllyDv,~llingFee:Sq. Fce~ -- 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 fees from Sec. 94 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) E Inspection for which no fee is specifically indicated, ($62.50/hr, minimum one hour) G. Inspection Outside Normal Business Hours, ($62.50fnr, minimum two hours) tt. Induslxial Plant ($62.50/hr) TOTAL AMOUNT DUE s s $__ $ $ $ $ qTo. ge