ElectricalPermit Application

Building and Safety Division/Permit Application CenterCity Hall / 555 Liberty St. SE / Room 320 / Salem, OR 97301-3513 503-588-6256 * baspac@cityofsalem.net If you need the following translated in Spanish, please call 503-588-6256.Si usted necesita lo siguiente traducido en español, por favor llame 503-588-6256.

Work site location and informationParent permit #

(required when site has other building permits)Street address of work site

Category of construction Commercial Manufactured Home Multi-family One/Two family

Type of Work New Addition Alteration/Repair

Sign Temporary Pole Limited Energy only

Project Description

People informationSame as

Applicant? Name Full Mailing Address Phone Number and Email address

Applicant (person responsible for the permit)Property owner Yes

NoContact (person receiving correspondence)

YesNo

Contractor (person or company doing the work)

YesNo

Oregon Construction Contractors Board (CCB) Number: ____________________Electrical Contractor License Number: ___________________Supervising License Number/Signature: ___________________ ______________________________Project information

New or enlarged exterior wall penetration? Yes NoNew or replacement of exterior equipment? Yes No

Plan review Please check all that apply. Plans must be submitted and review fees paid if any are checked. Service or feeder 400 amps or more where the available fault current exceeds 10,000 amps at 150 volts or less to ground, or exceeds 14,000 amps for all other installations Fire pump Emergency system Addition of new motor load of 100 HP or more Six or more residential units Healthcare facilities Hazardous locations

Emergency systems with a service or feeder 600 amps or more Building is 3 stories or more Marinas and boatyards Floating buildings Commercial-use agricultural buildings Installation of 150 KVA or larger separately derived systems "A", "E", "I-2", "I-3" occupancy Recreational vehicle parks Supply voltage for more than 600 volts normal

(For office use only)Permit #:

Electrical Permit Application-9/6/2019IAS Code(s): 4.2.1.1.5.5.1.3

Page 1 of 3

Fees*Number of inspections allowed per permit.Description Qty Each Total *NEW 1- and 2-family unit Total square feet of dwelling (both units), including attached garage.First 1,000 square feet or less $139.75 4Each additional 500 square feet or portion thereof $26.00 1Total costNEW multifamily dwelling unit (use only 1 of the methods below)Method 1 Total # of apartments

Square feet of largest apartment:Largest apartment 1000 sq ft or less $139.75

Largest apartment-Each additional 500 sq ft or portion $26.00Total cost of largest apartment

Total cost of largest apartment/2Total # of apartments -1 (largest apartment)

Total cost of additional apartments Total multifamily cost method 1

Method 2 (Allows for phased inspections)

Total # of apartments: $139.75Cost per apartment (flat rate):

Total multifamily cost method 2Total new multifamily cost

Services or Feeders (New, alteration, and/or relocation)200 amps or less $82.75 2201 amps to 400 amps $98.25 2401 amps to 600 amps $163.50 2601 amps to 1,000 amps $212.00 2Over 1,000 amps or volts $491.50 2Temporary Services or Feeders (New, alteration, and/or relocation)200 amps or less $67.25 2201 amps to 400 amps $89.00 2401 amps to 600 amps $129.50 2601 amps to 1,000 amps $212.00 2Over 1,000 amps or volts $491.50 2Branch circuits (New, alteration or extension, per panel)WITH service or feeder fee, each branch circuit $5.50 2WITHOUT service or feeder fee, first branch circuit $67.25 2Each additional branch circuit WITHOUT service or feeder fee $5.50 2Miscellaneous (service or feeder NOT included)Each manufactured or modular dwelling service and or feeder $67.25 2Pump or irrigation circle $67.25 2Sign or outline lighting $67.25 2Each additional inspection or re-inspection over allowable in any of the above. 52.00 2

Limited energy panel (Check all that apply) - **=work is exempt from licensing Audio stereo systems** Boiler controls Clock systems Fire alarm installations Garage door opener** HVAC** Instrumentation Intercom/Paging system

Landscape irrigation control** Landscape lighting & irrigation Medical Nurse calls Outdoor landscape lighting** Protective signaling/burglar alarm Vacuum systems** Voice/data/Video installations $67.25 2

Electrical Permit Application-9/6/2019IAS Code(s): 4.2.1.1.5.5.1.3

Page 2 of 3

ELECTRICAL PERMIT FEESA) Permit Subtotal (from above checklist)B) Minimum Permit Fee (only applicable if line A is less than $67.25) $67.25C) Permit Total (greater of A or B per above)D) Plan Review (25% of Permit Total – Line C x 0.25) + automation fee ($2.50<$50; $5>=$50)E) State Surcharge (12% of Permit Total – Line C x 0.12)G) Permit automation fee - $5.00

TOTAL PERMIT FEE

NoticesExpiration of application: This application is valid for 180 days after it has been accepted as complete.Inspections required: Approved city inspections must be completed before the work performed is enclosed.Terms and conditionsCorrect information: I hereby certify I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. Copyright release for government entities: I hereby grant permission to the City of Salem to copy, in whole or part, drawings and all other materials submitted by me, my agents, or representatives. This grant of permission extends to all copies needed for administration of the City’s regulatory, administrative, and legal functions, including sharing of information with other governmental entities.Indemnity: I, the permit applicant, shall indemnify, defend and hold harmless the City of Salem, its officers, employees and agents from any and all claims arising out of or in connection with work done under this permit.Owner installation: This installation is being made on residential or farm property owned by me or a member of my immediate family. This property is not intended for sale, exchange, lease, or rent. OAR 479.540(1) and 479.560(1).Owner permission: I have the legal right or permission from any property owner whose property is affected by the work covered under this permit to: 1) enter the property; 2) perform the work covered under this permit; 3) leave structures on or in the affected property. The issuance of this permit shall not be construed as permission or a grant of a legal right to enter upon or remain on any property affected by the work covered under this permit.Electronic signature certification: By attaching an electronic signature (whether typed, graphical or free form) I certify herein that I have read, understood and confirm all the statements listed above and throughout the application form. I agree (initials): ______

Authorized Signature: ______________________________________________________________________ Print Name: _____________________________________________ Date: ________________________

Not using Internet Explorer (IE 11)? Save the file to your computer and email to baspac@cityofsalem.net.

Electrical Permit Application-9/6/2019IAS Code(s): 4.2.1.1.5.5.1.3

Page 3 of 3