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FOR CITY USE ONLY Received By: Dam: Zoning By:. .City: R~ceipt #: Amount: $. ELECTRICAL PERMIT APPLICATION Please complete all Sections, 1 through 5 1. LOCATION OF INSTALLATION Parcel ID: -'.:- -?,, _g _ PERMITS ARE NON. TRANSFERABLE AND EXPIRE IF WORK ] IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE OR IF WORK IS SUSPENDED FOR 180 DAYS. ~A. CONTRACYOR INFORMATION 5.--O Fax: Property Owner: (please print) Mailing Address: City: State: Zip: I am the PROPERTY OWNER and own. reside in. or will reside in the completed structure and will be my own general contracto~ 1 understand that I must register a~ a con$truction contractor if the structure is sold or offered for sale before or upon completion~ lfl hire subcontractors. I will hire only subcontractors registered with the Construction Contractors Board. lf l change my n~ind 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 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 specifications w th th s app cation. MC 15-34 Rev 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) Items Cost (ea~h) 1000sq, ft. orless -- x $110.00=$__ Each addifional 500 sq; ft. or portian thereof -- x $20.00=$__ Sum Installation, Alteration or Relocation 200 amps or I~s il~ x $65.00 = $ 2 201 amps to 400 amps x $80.0{/= $ 2 401 ampsto6~0 amps x $130.00--$ 2 601 ampste 1000amps x $170.00=$ 2 Over 1000 amps or volts x $390.00=$ 2 R~connect Oaly x S55.00 = S 2 C. ~l~mgorary Service~Ft~lem Installation, AIteeaflom, or Relocation 200 amps ~ less x ~45.00 = $ __.2 201 amps to 400 amps x $55.00=$ 2 401ami~ to 600 amps -- x $110,00=$ 2 Over 600 amps or 1000 volta s~e "B" above D. Branch Clrc~l~ New, Alteration, or Extension Pee Panel al The fee foe branch ¢ix~uits with the vurehase of S~rvice or F~d~r Fee: Each branch ci~mt x $3,00 = $ b) The fee for branch circuits w*thout the ourchas~ of Service or Feede~ Fee: F~rst branch circuit x $50.00 = $ Each additional branch circuit x $3.00 = $ E. Miscellaneons (S~rvice or Feeder Not Included) Each pump or inlgation ¢imle x $55.00 = $ 2 Each Sign or Outline Lighting x $55.00 = $ 2 Signs) Circuit(s) or a Limited Energy Panel. Alteration or Entension x $55.00 = $ --. 2 FEES Al. Enter total of fees from Sec. ~ A2. Add State Surcharge (.05% x Al) SUBTOTAL B. Enter 30% of line A1 for Plan Review C. Investigation Fee (if mqalred) D. Reinspection 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, ($62.50dir, minimum two hours) $. H. Industrial Plant ($62.50/hr) $ TOTAL AMOUNT DUE $, $ $ $ $. $.