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Received By; <br /> <br />MARION COUNTY BUILDING i~SPECTION <br />~enetor Bldg, N~ 225 <br />220 HIgS Street NE <br /> Salem, Oregon 97301 <br /> <br /> Psone s88~147 <br /> Code-A.Phone 4:30 P.M. - 8=00 A.M. <br /> <br />ob Address: <br /> <br />ELECTRICAL PERMIT APPLICATION <br /> <br /> ~ ,¢~ ~,,¢~,~) Phone: Mailing Address; <br /> <br /> 0F~~ '-~//~ ~,~,. ' Phone; '" Address: <br /> <br />~ ~0ntractor~ No.; Home Builder~ Registration No.; <br /> ,ng 'T'"'"Ose of Residential ~ j New g .... Addition ~ Occupancy <br /> n's NO,: Building' Commercial ~ Alteration ~ Relocation ~ Change <br /> <br />Electrical Contn <br /> <br />Supervisin, <br />Electrician's NO,: <br /> <br /> No, RESIDENTIAL <br />__ Residence wiring les8 than 1000 sq, ft ................................. 6~[3 $ <br />--L Residence wiring less than 2000 sq. ft ................................. @ $ <br />__ Residencewiringover2000sq. ft .................................... @ $ <br />...... Electric heat installation in existing residence ........................... @ $ <br /> SERVICES <br />__ Temporary Construction Service ..................................... @ $ <br />____ Service change only in an existing residence ........................... @ $ <br /> Commercial or Industrial: <br />__ Service not over 100 amperes ....................................... @ $ <br />__ Service over 100 amperes but not more than 200 amperes ................. @ $ <br />__.. Service over 300 amperes but not more than 400 amperes ................. @ $ <br />__ Serviceover400amperesbutnotmorethan600amperes ................. @ $ <br />___ Service over 600 amperes ......................................... @ $ <br />__ Service over 600 volts ............................................. ~ $ <br /> COMMERCIAL AND INDUSTRIAL FEEDERS <br /> Installation of Alterations or Relocation of Diatributlon Feeders: <br />..__ NOt more than 100 amperes ........................................ @ $ <br />__ Over 100 amperes but not mon~ than 200 amperes ....................... @ $ <br />__ Over 200 amperes but not more than 400 amperes ....................... @ $ <br />__ Over400amperes ............................................... @ $ <br />__ Feederever600volts ............................................. @ $ <br /> MISCELLANEOUS <br /> A, Each trailer or mobile home space (Service equipment) .................. @ $ <br />.... B. Each supply for mobile home (Connection) ........................... @$ <br />__ C, Each ~rrigation pump (Attach a map showing location) ..................... @ $ <br />__ D, Eachelectricsignoroutlinelighting ................................ @$ <br />__ E, Each swimming pool (bonding) ................................... ~, $ <br /> BRANCH CIRCUITS <br />__ One new circuit;alteration or extension ............................... @ $ 20,00 <br />-- Twoormorenewclreuits;alteretionsorextensions ....................... @$ 30.00 <br />__ Other (es per NEC and Building Official) ......................................... <br />__ On-Site Technical Review (apply directly at Marion County only) ...................... <br />..... Industrial Plant Inspection (apply directly at Marion Coumy only) ...................... <br />__ ReinspectionFee ................................................ @ $ 20.00 <br /> FEE <br /> STATE SURCHARGE __ <br />Please return COMPLETE APPLICATION PLAN REVIEW FEE <br /> <br /> 50.00 <br />75.00 ~ co <br />105.00 <br /> 30,00 <br /> <br /> 30.00 <br /> 30,00 <br /> <br />45.00 <br />70.00 <br />100,00 <br />150,00 <br />200.00 <br />450,00 <br /> <br />25.00 <br />40.00 <br />70,00 <br />85,00 <br />120.00 <br /> <br /> 25.00 <br /> 25.00 <br /> 30.00 <br /> 30.00 <br /> 30,00 <br /> <br /> ...... INVESTIGATION FEE <br /> with [ne inaicama tee, FLEET SURCHARGE I <br /> ¢ ,/] -" TOTAL I <br /> la rea croaks heeecr // // ~ //~ <br /> <br />~ HOMEOWNERS - I hereby certify that I am the owner of the propeAy described above, at which location I propose to maker electrical installation for <br /> my own use and this p~per~ is not being construmed for sale, lease or ant. <br /> <br />SIGNATURE. OF APPLICANT: <br /> <br />MC 15-34 (Owner dr)lng his own work) <br />Rev, 12/88 <br /> <br /> <br />