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22S High Street NE <br /> Salem, Oregon g73~ <br /> <br />ELECTRICAL PERMIT APPLICATION <br /> <br />Owner: Phone: Address; <br /> <br />Sifu~ Address: ~ ~ ' Site NO.: Crce~ Street: ~,/~l~ <br />El~rlca~o~n~ No.: Home Builder~ Registration No.: <br /> <br />Supemising' .... I Use0f , Now ~ Addition ~ Occupancy <br />Electdcla~No.: ~ I~ ~I Building: ell g~ Alteration~ Relocotio~ ~ Cha~ge <br /> <br /> NO, RESIDENTIAL <br />__ Residence wiring less than 1000 sq. ft .................... . ............. @ $ 30.00 <br /> 'T Residence wiring lass than 2000 sq, ft ................................. @$ §0,00 <br />__ Residence wiring over 2000 sq, ft. ................ ................... @ $ 70;00 <br />__ Electric heat installation in existing residence ........... :. .............. @ $ 20.00 <br /> SERVICES <br />( Temporary Construction Service ..................................... @ $ 20.00 <br />__ Service change only in an existing residence ........................... @ $ 20.00 <br /> Commemlsl or Industrial: <br />__ Servlcenotoverl00amperes...~ ................................... @$ 30.00 <br />__ Service over 100 amperes but not more than 200 amperes ................. @ $ 50.00 <br />__ Serviceover200amperesbutnotmorethan400amperes. ................ @$ 70.00 <br />__ Service over 400 amperes but not more than 600 amperes. ................ @ $ 100.00 <br /> <br /> __ Service over 600 amperes ......................................... @ $ 130.00 <br /> __ Service over 600 volts ............................................. @ $ 300,00 <br /> COMMERCIAL AND iNDUSTRIAL FEEDERS <br /> Installation of Alterations or Relocation of Dlatrlbuflon Feeders; <br /> Not more than 100 amperes ........... ~ .... .................... @ $ 20.00 <br /> Over 100 amperes but not more then 200 a41[r~s l~. ~' ~' I~- -I~R* r'~:~ ' ~ $ 30.00 <br /> Over200amperos but not morethan400 a~s/,.~=. I,,.~,. ~..~l, .t~/,~, Ih,, t ~ $ 50.00 <br /> Feeder over 600 voltS ........................................... ~.~ j~ $ 80.00 <br /> <br /> __ A. Eachtrailerormobilehomespace(Servlceequlpme'ntF.~..Y.¥..i~,O./... @$ 20.00 <br /> E. Eachsupplyformobilehome(Connection) ........................... @$ 20.00 <br /> C, Eachlrdgatonpump(Attechamesshowinglo~ti~j~,~,~,10N./~H, td,nv ..... @ $ 20.00 <br /> __ D. Eachelectncs]gnoroutlicelighting ........ .".~,.u,h~.h~ ..... . @$ 20,00 <br /> <br /> BRANCH C RCUI'i'S ..... <br /> __ Onenewcimuit;slteraffonorextension .......................... ;.. :.@ $ 15.00 <br /> __ TWO or more new cimuits; alterations or extensions ....................... @ $ 20.00 <br /> __ Other (as per NEC and Building Official) ......................................... <br /> __ On-Site Technical Review (apply directly at Marion County only) ...................... <br /> __ Industrial Plant Inspection (apply directly at Marlcn County only) ...................... <br /> __ Relnspeotlce Fee ........................................................ <br /> FEE ~: 0(3 <br /> -%% STATE SURCHARGE .~,~ <br /> Please return COMPLETE APPLICATION PLAN REVIEW FEE <br /> with the indicated fee. INVESTIGATION FEE <br /> FLEET SURCHARGE <br /> TOTAL <br /> <br /> I ~g~eo to ma~ the electrical installatior~ accors~g to t~iffes plans ~ns seec~fl~atlons, the laws of the State of Oregon end the Ordinances of Marion County, <br /> $IGNATUREOFAPPLICANT' ~ 1 , -- ~ <br />~,mlOM EOWNERS - I hereby certify that I am the owner cf the property described abova, et which location I propose to make an electrical installation y own use and this property il not being constructed f~r ~alei lsase or rent. <br /> ~,GNATURE OF APPi.,CANT' ~ ~ <br /> Rev, 3/87 <br /> <br /> <br />