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Received By: ~~, MARION COUNTY BUILDING INSPECTION SeNator Bldg. NO. 225 220 Hlgl~ Street NE Salem, Oregon 97301 Phone 588-5147 Code-A-Phone 4:30 RM. - 8:00 A.M. ELECTRICAL PERMIT APPLICATION Phone; MaiJJng Address; [dress: Cro~ ~eet: ;~1 Firm; Phone: Address; ti~ing Ele~rician: Phone: Address: 2al Contra~or~ No.: Home Bu[Ider~ Regi~¢ation No,: ' ' /~'~g Use of ¢ / [.~esldential ~ New ~¢ Addition B Occupancy ;ian~ No,; Building: Job Address: Elect/[cal Fir Supervising Supervisin No. RESIDENTIAL __ Residence wiring less than log0 sq. ft ................................. @ $ 50.00 ...... Residence wiring ~ess than 2000 sq. ft ................................. @$ 75.00 __ Resldencewiringover2000sq. ft .................................... @$ 105,00 __ Electric heat installation in existing residence ........................... @ $ 30,00 SERVICES __ Temporary Construction Service ..................................... @ $ 30.00 __ Service change onlyin an existing residence ........................... @ $ 30.00 Commercial or Induatrlah __ Servicecetoverl00amperes ....................................... @$ 45.00 __ Serviceoverl00amperesbutnotmorethan200amperes ................. @$ 70;00 ..... Service over 200 amperes but not more than 400 amperes ................. @$ 100.00 __ Servlcsover400amperesbu;notmorethae600amperes ................. @$ 150.00 __ Serviceover600amperes ......................................... @$ 200.00 ..... Serviceover6g0volts ............................................. @ $ 450,00 COMMERCIAL AND INDUSTRIAL FEEDERS Installation of Alterations or Relocation of Distribution Feeders: ...... Not more than 100 amperes ........................................ @ $ 25.00 __ Over 100 amperes but not more than 200 amperes ....................... @ $ 40,00 ...... Over 200 amperes but not more than 400 amperes ....................... @ $ 70.00 __ Over400amperes ............................................... @ $ 85,00 __ Feederover600volts ............................................. @ $ 120,00 MISCELLANEOUS __ A. Eachtrailerormobilehomespace(Servl~eequiprnem) .................. @$ 25.00 __ B. Eeohsupplyformobilehome(Connection) ........................... @$ 25.00 ....... C. Each irrigation pump (Attach a map showing location) ..................... @ $ 30.00 __ D. Each electric sign or outline lighting ................................ @ $ 30.00 __ E, Each swimming pool(bonding) ................................... @ $ 30.00 BRANCH CIRCUITS ..... One new cimult; alteration or extension ............................... @ $ 20.00 ..... Two or more new cireuits; alterations or extensions ....................... @$ 30,00 __ Other (as par NEC and Building Official) ......................................... __ On-Site Technical Review (apply directly at Marion County only) ...................... .......... Industrial Piers Inspection (apply directly at Marion County only) ...................... __ Reinspactlon Fee ........................... ,? ~.,~ .................. @ $ 20.00 FEE STATE SURCHARGE Please return COMPLETE APPLICATION ~"~ I'~N'V'~; ~.~;1~'~ ~ ~ ~ with the indicated fee. //] FLEET SURCRAROE , , ~;i/¢//ng/t~/,~it lagreetomaketheelectdcall~stalia' ac ording mitted~ansands~eci~cati~ns~the[aws~ftheState~reg~nandthe~rdinen¢es~Meri~C~un~y' SIGNATUR~OFAPPLICA ! [J~ "~'/--~' ~ (Supetvi$ingEleCtri¢ian) L~O~) ~'0. HOMEOWNERS - I hereby certify that I am the owner of the preperty described above, at which location I prepo~to make an electrical installation for my own use and this property is not being constructed for sale, lease or rent, SIGNATURE 01: APPLICANT;