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FOR CITY USE ONLY R~eived'By: ~ Date: Zoniag By: City: Receip~ #: _Ammmt: $ ELECTRICAL PERMIT APPLICATION Please coz~plete all Sections, 1 through 1. LOCATION OF INSTALLATION parcel rD: PERMITS ARE NON. TRANSFERABLE AND EXPIRE IF WOP.~ I IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE OR IF WORK IS SUSPENDED FOR 180 DAYS. 2A. CONTRACTOR INFORMATION C°ntract°r: ~-~ ~0~ ~L~'~L~ Co.~mr~ ~0 ~o.: Su~.isorLicenseNo.: ~ t ~ ~ Signatur~ of Surmising Elec~c~: ~ ~. FOR O~R ~STA~A~ON ~ Owner: ~le~e pdnO Mailing Address: City: State: Zip: I am the PROPERTY OWNER and own, reside in, or will reside in the completed structure and wilt be tn), 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, lf l hire subcontractors, I will hire only subcontractors registered with the Construction Contractors Board, lf l change my mind and do hire a genera~ conlrac~or 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 d~es not require a plan ~eview. We will provide plan ] review service if you complete Section 5B and submit two (2) sets of plans and specifications with this application. MAR/ON COUNTY BUILDING INSPECTION 3150 Lancaster Dr. NE - Suite C Salem, Oregon 97305 m - 4:30pm 24 HR Inspection Line 373-4427 FAX 588-7948 IFEE SCHEDULE (complete and enter total in Al) ~?~' ~7~'~ ~3 1000 sq. ft, or less Each additional 500 sq. ft. or portion thereof -- Limited Energy Each Manufactu~xl Home or Modular Dwelling Service or Feeder Items Cost (each) Sum -- x $110.00=$__4 x $20.00 = $ x $30.00=$__1 -- x $52.00=$ 2 B. Services or Feeders (Do~s not include branch Circuits, see section D) Installation, Alteration or Relocation 200 anaps or less x $65.00 = $ -- 2 201 amps to 400 amps -- x $80.00 = $ -- 2 401 araps to 600 amps -- x $130.00 = $ 2 601 amps to I000 amps -- x $170.00 = $__ 2 Over 1000 amps or volts -- x $390.00--$__2 ReeonnectOnly -- x $55.00=$__2 Pi~t branch circuit ] x $50,00 = $ ~ ~ Each additional branch circuit x $3.00 = $ J~ 5. FEES A 1. Enter total of fees from Sec. ~ A2. Add State Surcharge ~ x Al) SUBTOTAL B. Enter 30% of l~e Al 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, ($62.50/hr, minimum two hours) H. lndusUia! Plant ($62.50/hr) TOTAL AMOUNT DUE $__ $ $ $ $__ $__ $__ MC 15-34 Rev 9/98