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Received By: <br /> <br />MARION COUNTY BUILDING INSPECTION <br />Senator Bldg, No. 225 <br />220 High Street NE <br /> <br /> · -~ ~--Salem, Oregon 97301 <br /> Phone 588-S147 <br /> Code-A-Phone 4;30 RM, - 8:00 A.M. <br /> <br />~-o6 A~Jdress: ~ <br /> <br />irm~ <br /> <br />ELECTRICAL PERMIT APPLICATION <br /> <br />Supervising Electrician: Phone; <br /> <br />Electrical Contractor% NO.: <br /> <br />Mailing Address: <br /> <br />Cross Stneet; <br /> <br />Address: <br /> <br />Address: <br /> <br />Home Builder's Registration No,: <br /> <br />Supervising Useof Residential ~ New [] <br />Electdclan% No,:" Building: Commercial [] AIteratlon [] <br /> <br />Addition <br />Relocation <br /> <br />Occupancy <br />Change <br /> <br /> NO, RESIDENTIAL <br /> Residence wiring less than 1000 sg, ft ................................. (~!! $ <br />.... Residence wiring less than 2000 sq. ft ................................. ~ $ <br />.... Residence wiring over 2000 sq. ft .................................... (a3 $ <br />Electdc heat installation in exlstlng residence ........................... 8~$ <br /> SERVICES <br />....... Temporary Construction Service ..................................... (~-;! $ <br />___ Service change only in an exJating residence ........................... (?? $ <br />Commercial or Induatria[: <br />Service not aver 100 amperes ....................................... ~i~ $ <br />___ Service over 100 amperes but not more than 200 amperes ................. (6, $ <br />Service over 200 amperes but not more than 400 amperes ................. ~> $ <br />Service over 400 amperes but not more than 600 amperes ................. (/.~ $ <br />Service over 600 amperes ......................................... (8~> $ <br />.... Service over 600 volts ............................................. ~ $ <br /> COMMERCIAL AND INDUSTRIAL FEEDERS <br />Installation of Alterations or Relocation of Distrlbutlor~ Feeders: <br />___ Not more than lOOemperes ........................................ (~z) $ <br />__ Over 100 amperes but not more than 200 amperes ....................... ¢i> $ <br />Over 200 amperes but not more than 400 amperes ....................... ((i~ $ <br />Over 400 amperes ............................................... (-~ $ <br />__ Feederover600volts ............................................. ~! $ <br /> MISCELLANEOUS <br />A. Esch trailer or mobile home space (Service equipment) .................. (~$ <br />__ B, Each supply for mobile home (Connection) ........................... ('4/$ <br />__ C, Each irrigation pump (Attach a map showing location} ..................... ~, $ <br />......... D. Eachelectricsignoroutllnellghting ................................ {~¢$ 30,00 <br /> E. Each swimming pool (bonding) ................................... ('¢i~ $ 30.00 __ <br /> RRANCH CIRCUITS <br /> One new Circuit; alteration or extension .............................. (!i~$ 20.00 <br /> ! Two or more new ci~Cults; alterations er extensions ....................... (i~~ $ 30,00 <br />..... Other (as per NEC and Building Offlcial) ......................................... <br />--- On-Site Technical Review (apply directly at Marion County only) ...................... <br /> Industrial Plant Inspection (apply directly at Marlon County only) ...................... <br />___ Reinspection Fee ................................................ ('~z~ $ 20.00 <br /> FEE <br /> STATE SURCHARGE <br />Please return COMPLETE APPLICATION PLAN REVIEW FEE __ <br /> <br /> 80.00 __ <br /> 75,00 <br />105.0g <br /> 30.00 __ <br /> <br /> 80.00 __ <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 /> <br /> with the indicated fee, INVESTIGATION FEE <br /> .~ FLEET SURCHARGE ~ <br />I agree to make I~e e~e~rical mstal~ ~~cifications, the law, of the ~,, Of Oregon and the Ordina,oes of Marion County, <br />SIGNATURE OF APPLICANT: ., ¢ ~ Job No: <br /> HOMEOWNERS - I hereby certify that I am the owner of the proper~ described above, at w~ch location I propose to make an electrical installation for <br /> my Own use and thi$ property is not bein~ co~stru~ed for sale, leace or rent. <br /> <br />SIGNATURE OF APPLICANT:. <br /> <br />MC 15-34 (Owner doing his ~wn work) <br />Rev. 12/88 <br /> <br /> <br />