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*i-FOR ~ USE ONLY Received By: Date: Zoning By: City: Receipt ~ Amount: $. 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 tTA1~) .- OO [ O)t~ ELECTRICAL PERMIT APPLICATION I I Please complete all Sections, I through 5 1. LOCATION OF INSTALLATION Pexcel ID: Zip: Phone: Cross Street/Directions: PER, IlKS ARE NON-TRANSFERABLE AND EXPIRE IF WORE IS NOr STARrEO wtratN gao DAYS OF ISSUANCE OR IF WORK tS SUSPENDED FOR 180 DAYS. 2A. CONTRACTOR INFORMATION Property Owner: (plec~e 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 contractor. 1 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 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 w th th s app cation. Number of Inspections per permit allowed -- A. Residen0al Per Unit Service Included: 1000 sq. fi. or less Each additional 500 sq. 1~, or portion thereof -- Limited Energy Each Manufactured 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 (Does not include branch Circui~ see section D) lustallation, Alteration or Relocation 200 amps or less -- x $65.~0 = $ --- 201ampsto400amps -- x $80.00=$___ 401 ampsto600amps -- x $130.00=$__ 601 amps to 1000 amps -- x $170.00 = $ -- Over 1000 amps or volts -- x $390.00 = $ -- Reconnect Only -- x $55.00 = $ --- C. Temporary Services/Feeders Installation, Alterations, or Reldealion 200 amps or less -- x $45.00 -- $__ 201 amps to 400 anaps -- x $55.00 = $__ 401 ampsto600arnps -- x $110.00 =$ Over 600 amps or 1000 volts see "B" above D. Branch Circuits New, Alteration, or Extension Per Panel a) The fee for branch circalts with the ourehase of Service or Feeder Fee: Each branch circuit -- x $3.00 = $ -- b) The fee for branch circuits without the ourchase of Seveice or Feeder Fee: First branch circuit __ x $50.00 = $ -- Each additional branch circuit __ x $3.00 = $ -- E. Miscellaneous (Service or Feeder Not Included) Each pump or irrigation circle -- x $55.00 = $ -- Each Sign or Outline Lighting -- x $55.00 = $ Signal Circuit(a) or a Limited Energy Panel, Alteration or Extension __ x $55.00 = $ __ E Each additional Impoeflon over the allowable in any of the above, per inspection -- x $50.00 = $ -- G. Minor Installation Labels Pack of 10 labels @$10.00 each __ x $100.00 = $ __ (gold only to Electrical Contractors) H. Industrial Plant -- x $62.50&r = $ -- One/I~voFamllyDwel~ngFee:Sq. Feet __ x $ .09=$__ Dwelling Permit Labels {For Single Family Dwellings Only) OTHER, as required by the Building Offletal $__ TOTAL $ -- N/C S. FEES A 1. Enter total of fees from Sec. ~ A2. Add State Surcharge (.05% x Al) SUBTOTAL B. Enter 30% of line Al for Plan Review C. Investigation Fee (if required) D, Ralnspecfion Fee ($50.00) E. Additional Plan Review ($62.50/hr, minimum one-half hour) F, Inspection for which no fee is specifically indicated, ($62.50thr, minimum one hour) G, Inspection Outside Normal Business Hours, ($62.50/hr, minimum two hours) H. lndustxial Plant ($62.50/hr) TOTAL AMOUNT DUE $ $ $ $ $ $__ $ $ $__ MC 15-34 Rev 9/98