Electrical Renewable Energy Permit Application - City Of Salem Building And Safety Division Page 2
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1
2ELECTRICAL PERMIT FEES
A) Permit Subtotal (from previous page)
0.00
B) Minimum Permit Fee (only applicable if line A is less than $67.25)
$67.25
0.00
C) Permit Total (A or B per above)
0.00
D Plan Review (25% of Permit Total – Line C x 0.25) + automation fee ($2.50<$50; $5>=$50)
0.00
E) State Surcharge (12% of Permit Total – Line C x 0.12)
0.00
F) Archive Fees for plans
>=C Size pages
$1.75
0.00
<C size pages
$.50
0.00
G) Permit automation fee - $5.00
0.00
TOTAL PERMIT FEE
Notices
Associated permits: All building permits associated with this permit are applied for separately.
Expiration of application: This application is valid for 180 days after it has been accepted as complete.
Plan review requirements: Renewable Electrical Energy Systems in excess of 25 kva are considered complex
and require two (2) sets of plans to be submitted for review.
Terms and conditions
Correct 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.
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: ________________________
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IAS 4.2.1.3.1 - 8/7/17
Electrical Renewable Energy Permit Application - Page 2 of 2
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