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FOR CITY USE ONLY RecUrred B~: Date: Zo~n~By: .City: Receipt #: Amount: ELECTRICAL PERMIT APPLICATION Please complete all Sections, 1 through $ 1. LOCATION OF INSTALLATION Parcel ID: city: (- ~.Z4~_~fO --'/Zip: Phone: 7~:'~ -- P~trs A~ ~o~.r~s~ff~a~ n~° ~xrt~ tr wo~ [ IS NOT STARED WITHIN 180 DAYS OF ISSUANCE OR IF . non ssvstr v roe mo oars. . 2A. CO~R INfO,ON Su~r Licen~ No.: Signat~e of Surmising Em~eian:~ ~. FOR O~R INSTAL~ON Prope~y Owne~ (please print) Mailing Address: City: S~ate: Zip: I am the PROPERTY OWNER and own, reside in, or will reside in the completed structure and will be my own general contractor. 1 understand that I mu~t register as a construction contractor if the structure is sold or offered for sale before or upon completio~ Ill 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 immediately notify 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 plans and specifications with this application. MARION COUNTY BUILDING INSPECTION 3150 Lancaster Dr. NE - Suite C Salem, Oregon 97305 8:00am - 4:30pm 24 HR Inspection Line 3734427 FAX 588-7948 4. FEE ~CHE~ULE (¢mnplete and enter total in Al) Number of Inspections per permit allowed A. R~sidential Per Uha ~er,r~ Induded: I000 sq. ft, or less Each additional 500 sc!. fl. or Portion thereof Limited Energy Each Manufactore~ Home or Modular Dwelling sea'vice or Feede~ lrcms Cost (each) Stttn __ x $110.00=$__4 x $20.00 = $__ -- x S30.00=$__1 -- x $52.00=$ 2 B. Services Or F~IOTM (1~ not include bm~ct~ Circuits, Me s~cflofl D) Imtalla~on, Alteration or Relocation 20l amps to 4OO amps -- x $80.00=$ 2 401ampste600amps __ x $130.00=$ 2 601 amps to I000 amps -- x $170.00 = $ 2 Ovcr l000 amps or volts -- x $390.00=$ 2 Reconn~:t Only -- x $55.00 = $ 2 C. Tempe~r~ 8ervlee~eeder~ 200 a_mps or leas -- x $45.00 = $ 2 201amps to 400 ampa -- x $55.00=$ 2 401 ampste600aml~ ~ x $110.00=$__2 New, Alteration, or Extension Per Panel a) The fee for branch ch'cuRs with the otucha~e of Service or Feede~ Fee: Each branch circuit -- x $3.00 = $ -- ourchase of Service or Feeder First branch circuit -- x $50.00 = $ -- I~ach additional branch ch~:uit __ x $3.00 -- $ -- Miscellaneous (S~rvtce or Feeder Not ..7) Each pump or J~gation circle x $55.00 = $ Each Sign or Outline Lighting x $55.00 = $ 2 Panel, Alteration or Extension -- x $55.00 = $ 2 Each additional Inspection almve, per inspection -- x $50.00 = $ -- G. Minor lmtellation Labels Pack of 10 la~els @$10.00 each -- x $100~00 = $ __ H. lndustrtal Plant __ x ~ = $ ~FamflyDwell~gFee:Sq. Feet -- x $ .09=$__ Dwelling Permit Labels (For Singio Family Dwallings Only) N/C OTHER, as ~lui~d by ~e Ballding ~ $ FEES Al. Enter total of fees from Sec. g4 A2. Add State Surcharge (.05% x Al) SUBTOTAL B. Enter 30% of line A 1 for Plan Review C. Investigation Fee (if required) D. Rcinspectlon Fee ($50.00) E. Additional Plan Review ($62.50Par, 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. Industxial Plant ($62.50/hr) TOTAL AMOUNT DUE $ MC 15-34 Rev 9/98