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FOR CITY USE ONLY Received By: Date: Zoning By: City: Receipt #: Amount: $ ELECTRICAL PERMIT APPLICATION Please complete all Sections, 1 through 5 1. LOCATION OF INSTALLATION IParcel ID: PERMITS ARE NON. TRANSFERABLE AND EXPIRE IF WORK I IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE OR IF ~ WORK IS SUSPENDED FOR 180 DAYS. ] Mailing Address: City: State: Zip: Contractors Board No.: Supervisor License No.: Signature of Supervising Electrician: 2B. FOR OWNER INSTALLATION City:/~I~%t/tTtC stat : zip: I am the PROPERTY OWNER and own, reside in, or will reside in the completed stnwmre and will be my own general contractor. 1 understand that I mu~r register as a construction contractor if the stnwture is sold or offered for sale before or ttpon completion, lf l hire subcontractors, I will hire only subcontractors registered with the Construction Contractors Board, If I change my mind and do hire a general contractor who is registered with the Construction Contractors Board, I will itmnediately notify Marion Coun~ of the name of the contractor. Owner's Signature: 3. PLAN REVIEW SECTION Marion County does not r~luire a plan review. We will provide plan review se'~iee if you complete Section 5B and submit two {2) sets of pans and spec ficat ohs w th th s appl cation. MC 15-34 Rev. 9/99 MARION COUNTY BUILDING INSPECTION 3150 Lancaster Dr. NE - Sff~te C Salem, Oregon 97305 8:00am - 4:30pm 24 HR Inspection Line 373-4427 FAX 588-7948 Number o~ Inspections p~r permit allowed A. Residential Per Unit ~ervice Included: 1000 sq. ~, or less Each additional 500 sq. ft. or portion the~of -- Limited Eneegy Each Manufactured Home or Modulax 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 (Does not include branch Circuits, see section D) 200 an~,~ o~ [~ [ x s~.oo = s ~.0~ 2 201 amp~ to 400 amps ~ x $80.00=$__2 401 amps to 600 amps -- x $130.0(I = $ 601 amps to 1000 amps -- x $170.00 = $__ 2 Over 1000 amps or volts -- x $390.00 = $ -- 2 R~c~v, ectOnly -- x $55.00 =$__2 C. Temporary Services/Feeders Installation, Alterations, or Relocation 200 amps or less -- x $45.00=$__2 20t amps to 400 amps -- x $55.00=$__2 401 ampsto600 ~unps -- x $i10,00 --$__2 Over 600 amps or 1000 volts se~ "B" above D. Branch Circuits New, Alteration, or Extemion Per Panel First branch circuit -- x $50.00 = Each additional branch circuit -- x $3.00 = $ E. Miae~l~ua {SersM~ or Ir~l~r Not lnck~ded) Each pump or irrigation circle -- x $55.00 = $ -- 2 Each Sign or Outline Lighting __ x $55.00 = $ -- 2 panel, Alteration or Extension ] x $55.00 = $ ~2 F. Each additional Inspection One/rwoFamilyDwellin~Fee:$q. Feet __ x $ .09=$__ TOTAL $ 5. FEES Al. Enter total of fees from Sec. #4 A2. Add State Surcharge (.07% x A1 ) SUBTOTAL B. Enter 30% of line A 1 for Plan Review $ C. Investigation Fe~ (if required) $ D. Reinspection Fee ($50.00) $ E. Additional Plan Review ($62.50th~, 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. Indusuial Plant ($62.50/hr) TOTAL AMOUNT DUE $ 0 $ O