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A :: phone:sSa.,5147: ::
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<br />ELECTRICAL PERMIT APPL CATION
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<br /> Owner: ~, ~, ~ i ~/'/_ ~ / , Phone: Address:
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<br />~ ~/ ~ / ~ , ~ ~ / . Site~ Cross Street:
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<br /> 'Supewisin~Electrlcian~ ~ --I~_ ·~e~--~_~ ~dr~ ~, ~
<br /> Ele~rio~l Oontra~tor~ No.: '. ~ Nome Bull~e[~ ~gi~n
<br /> 8upe~vislng ' ~~ Useof New ~ ' ~dition ~ O~up~ncy
<br /> Ele~rician'sNo,~ ~<~ / Building; Ater~ton~ Relocation
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<br /> No, RESIDENTIAl-
<br /> · . Residence wiring less than 1000 sci. ltl .... . ...... :; .... @ $ 30.00
<br /> __ Reeldencew{rlnglessthan2OOOsq. ff..:, ... .......................... @ $ §0,00
<br /> __ Residence wiring over 2000 sq. ft ...... ;,... ....................... @ $ 70.00
<br /> Electric heat ~nstaH&tion in :existing residence :,; ......... ;,, .......:. .... @ $ 20.00
<br /> SERVICES
<br /> __ Temporary Construction Se~,,ice ..................................... @ $ 20,00
<br /> __ Serviceohangeonly in an existing residence ........................... @ $ 20.00
<br /> Commemlal or InduStrial:
<br /> __ Serv~cenoteverl00arnperes .................. ;. ................... @ $ $0.00
<br /> __ Servlceover 100 amperes but not more than 200 amperes ................. @ $ 50.00
<br /> __ Se~iceever2OOamperesbutnotmorethen4OOemperes,, ............... @$ 70.00
<br /> __ Servlceever4OOamperesbumotmorethan6OOemperes ................. @$ 100,00
<br /> __ Service oVer 6o0 amperes ......... ....... .,.,;,. .................. @ $ 130.cc
<br /> __ Service over 600 volts ............................................. @ $ $00,00
<br /> COMMERCIAl- AND INDUSTRIAL FEEDERS
<br /> Installation of Alteratlona or RelOCation of Distribution Feeders:
<br /> __ Notmorethanl00amperes ........................................ @$ ~0.00
<br /> Over 100 amperes but not more.lhan 200 amperes ....................... @ $ 80.00
<br /> __ Over 200 amperes but'not morethan 400 amperes, .... ....... ; .....:~;; ,..
<br /> __ Over 400 amperes .... / ................ ..... ~, ;....:.: ..... ........
<br /> Feeder over 600 volts .......... ............. ,...:, ..., ............. @ $
<br /> MISCELLANEOUS
<br /> __ A. Eachtrailer or mobile homo apace ($e~vi~e equipmeht). ,,. ~. ............ @ $ 20.00
<br /> __ B, Eachsupptyforrnobilehome(Connection)........ ' ................... @$ 20,00
<br /> __ C. Each Irrigation pump (Attach a map showing to~tton) ..................... @ $ 20,00
<br /> D. Each etactric sign oroutlinelighting .... . ,. ii, . t .: ...... ;.,,. @ $ 20.00
<br /> E. Eechre$1dentlalswlmmingpool ...... i:, ,i.:,.,:;. ,.:;.,,, @$ 20,00
<br /> ~ BRANCH CIRCUITS ·
<br /> Onenewcircuit;alterationorextension :;. .':, ....... :. ............ @$ 15,00
<br /> __ Twoormorenewcircuits;alteretion$orexteneion$1 , ....... @$ 20,00
<br /> Other (as per NEC end Building officiaf) ..,...,. ,:... ,., .......................... ,
<br /> Ob-Site Technical Review (apply directly at Madon County=only) ..................;...
<br /> I-
<br /> __ Industrial Plant Inspection (apply directly at Mari6n County only) ...................,..
<br /> __ Reinepectlon Fee, ............................................ . ........... .
<br /> FEE ::
<br /> STATE:SURCHARG:E
<br /> Please return COMPLETE APPLICATION PLAN REVIEW FEE
<br /> with the indicated fee. INVESTIGATION FEE
<br /> FI'EE'rSURCHARGEToTAL $
<br />I ~jree to rneke the electrical Installatton according to the submitted plans and spe~ificaflons, the laws of the State of Oregon and the Ordinances of Marion County.
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<br />[] HOMEOWNERS: [ hereby dertity that Iarn the owner of the properly described above at which location I propose to make an electrical installation for
<br /> my own use and this properS' s not be ng constructed for sale, ease or rent.
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<br />SIGNATURE OF APPLICANT:
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<br />MC 13/34
<br />Rev. 3/87
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