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FOR CST'/USE ONLY Received By:'~ Date: Zonin~g By: .City: R~ceipt #: Amount: $. ELECTRICAL PERMIT APPLICATION Please complete all SectionS, I through S 1. LOCATION OF INSTALLATION P~rcel ID: Panel Owner: Cross Str~e~/Dircctions: 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:. Mailing Address: City: ~1{~ State: Contrantor License No.: ~,~1-- IqTC... Supervisor License No.: ~0~ S Signature of Supervising Electrician'.~? lB. FOR OWNER INSTALLATION Property Owner: (~lease print) Mailing Address: City: State: Zip: I am the PROPERTY OWNER and own, reside in, or wdl reside in the completed structure and will be my own general contractor. I understand that 1 mu~t 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 general contractor who is registered with the Construction Contractors lloard, I will immediately notiJ~ 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 p aris and spec fications with this application. 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 (c°mlfiete and enter total in Al) 1000 sq, ft. or less Each additional 500 sq. ft. or portion thereof -- Limited Energy Each Manufactured Home or Modular Dwelling Service or Feede~ Items Cant (e~h) Sum __ x $110.00=$ 4 x $20.00 -- $ -- x $30.00=$__1 $52.00=$__.2 B. Services or Feeders (Does not lnclud~ branch Circuits, see section D) Installation, Alteration or Relocation 200 amps or less ~ x 201amps to 400 amps __ x $80.00--$ 2 401 amps to 600 amps __ x $130.00=$ 2 601 amps to 1000 amps -- x $170.00 = $ __2 Over l000 amps or volts -- x $390.00=$__2 R~conneet Only -- x $35.00 = $ 2 C. Temporm-y Service~Feeders Insinllation~ Alterations, or Relocation 200 amps or less -- x $45.00 -- $ . 2 201amps to 400 amps -- x $35.00=$ 2 401 amps to 600 amps -- x $110.00=$ 2 Over 600 amps or 1000 volts see "B' above Reanch Circuits New, Alteration, or Extension Per Panel a) The fee for branch circuits with the ourchase of g~icc or Feeder Fee: Each branch circuit ~ x $3.00 = $ b) The fee for branch circuits without the ourch~e of Service or Feeder Fee: First branch circuit -- x $50.00 -- $ -- Each additional branch eitcult -- x $3.00 = $ -- Miscellaneous (Service or Feeder Not Inelmlad) Each pump or irrigation uircle -- x $55.00 = $ -- 2 Each Sign or Outline Lighting x $55.00 -- $ -- 2 Signal Circuit(s) or a Limited Energy P~nd, Alteration or Extension __ x $55.00 = $__ 2 Each additional Inspection over the allowable in any of the ubove, perimpection -- x $50.00=$~ Minor Iminlintion Labels Pack of 10 labels @$10.00 each -- x $100.00 = $ -- (Sold only to Elccuical Contrac~rs) Industrial Plant __ x $62.50&r = $ onefrwoFamllyI)welgngpee:Sq. Feet __ x $ .09=$ Dwelling Permit Labels (For Single Family Dwellings Only) E G. Orl-u~R, as required by the Building Official TOTAL Al. Enter total of fees from Sec. g4 A2. Add State Surcharge (.05% x Al SUBTOTAL B. Enter 30% of line A1 for Plan Review C. Investigation Fee (if required) D. Reinspeclion Fee ($50.00) E. Additional Plan Review ($62.50/hr, minimum one-half hour) F. 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. Industrial Plant ($62.50/hr) TOTAL AMOUNT DUE $ ISq'oo MC 15-34 Rev 9/98