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Received By: Sen~4or Bid9, No- 225 <br />Date: _ ~ --~ Salem, Oregon 97301 <br /> <br /> ELE~RICAL PER~IT APPLICATION <br /> <br />Owner: Phone: Mailing Addn~as; ' ~"~ IU/V <br />Job Address'. Site NO.~,~,~¢ Orca, Street; <br />Electrical Fir~; Phone; Addross: <br />Supervising Ele~rician: Phone: Add,ss; <br /> <br />Electrical Contraotor~ No,; Homo Bullder~ Registration No,; <br />Supervising 8~e ~f Residential ~ New ~ ......... ~i't~'~'~'"'"'"' ~ Occupancy <br /> Commercial ~ Alteratio~ Change <br /> <br /> No, RESIDENTIAL <br />__ Residence wiring leasthan 1000 sq. ft ................................. @ $ 50.00 <br />__ Residence wiring less than 2000 sq, ft ................................. ¢4 $ 75.00 <br />__ Res[dencewiringover2000sq, ft .................................... @$ 105.00 <br />__ Eloclrlc heat Installation In existing residence ........................... @ $ 30,00 <br /> SERVICES <br />__ Temporary Construction Service ..................................... @ $ 30.00 <br />__ Service change only in an exisllng residence ........................... @ $ 30,00 <br /> Commercial or Industrial: <br />,__ Service not over l00 amperes ....................................... @$ 45,00 <br /> Service over lOC amperes but not mom than 200 amper9~.. ¢ ,;,. ............ @ $ 7O.OO <br />__ Service over 200 amperes but not mom than 400 amperes, ~, .............. @ $ 100.00 <br />__ Bervlceovor400omperesbutnotmorethan60Oamperes ................. @ $ 150,00 <br />__ Serviceover600amperes ......................................... @ $ 200,00 <br />__ Serviceaver600volts ............................................. @ $ 450,00 <br /> COMMERCIAL AND INDUSTRIAL FEEDERS <br /> Installation of Alterations or Relocation of Distribution Feeders: <br />__ Notmorethan 100amperes ........................................ @ $ 25.00 <br />__ Over 100 amperea but not mom then 200 amperes ....................... @ $ 40.00 <br />__ Over 200 amperes but not mom than 400 amperes ....................... @ $ 70.00 <br />__ Over400amperes ............................................... @$ 85.00 <br />__ FeederoverG00volts ............................................. @ $ 120,00 <br /> MISCELLANEOUS <br />__ A. Eechtrailerormobilehomespoce Setvl~eequicrnent .................. @$ 25.00 <br />__ lB. Each supply for mobile home (Connection) ........................... @ $ 25.00 <br />__ C. Each irrigation pump (Attach a map sl~owing location) ..................... ¢z~ $ 30,00 <br />__ D. Each electric sign er ootlino lighting ................................ @ $ 30.00 <br />__. E. Each swimming pool (bonding) ................................... @ $ 30.00 <br /> BRANCH CIRCUITS <br /> One new cJmult; alteratlon or extension ............................... @ $ 20.00 <br />~ Two or more new circuits; alterations or extensions ....................... @ $ 30,00 <br />__ Other (as per NEC and Building Official) ......................................... <br />__ On-Site Technical Review (apply dlreCtly at Marion County only) ...................... <br />__ Industrial Plant Inspectlon (apply directly at Marion County only) ...................... <br />.__ ReJnspectJon Fao ................................................ @ $ 20.00 <br /> FEE <br /> STATE SURCHARGE <br />Please return COMPLETE APPLICATION PLAN REVIEW FEE <br /> INVESTIGATION FEE <br />with the indicated fee. FLEET SURCHARGE <br /> TOTAL <br /> <br />I agree to make the ele¢(rlcal installation according to the submitted plans and specifications, the laws of the State of Oregon and the Ordinances of Marion County, <br /> <br />~ HOM~OWNBR8 - I here~ cedi~ that I am the owner of the p~perty described above, at which location I propose to make an electrical installation for <br /> my own use and this proper~ Is not being ~nstructed for sale, Ieee or rent, ¢~ <br /> <br />SIGNATURE OF APPLICANT', ,, ~, <br />MC 15-34 (~ner doing hS o~work) <br />Rev. 12~8 <br /> <br /> <br />