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Received By: Date; _ MARION COUNTY BUILDING INSPECTION 220 High Street NE Salem, Oregon 97301 Phone ~88-8147 Code-A-Phone 4:80 EM. - 8:00 A.M. ELECTRICAL PERMIT APPLICATION Job Address: trioaJ Firm: , ~ SUp/C..{viei~g Ele.ctf¢ian: _ · -. ' Supervising [ Useef Elect rieia o's N?_.~'O {~.D ~,")_,_.%~ J' Building; Phone: Phone: Cross Street; kddreae. - ~ , Home Builder% Registration No,: I "~'es[dential ~ New [] _..-.-- Addition [] Occupancy Commercial f"'l J Alteration ~ Relocation [] Change No, RESIDBNTIAL _.__ Residence wiring Ieee then lO00 sq. ft ................................. ~} $ ___ Residence wiring less than 2000 eq, ft ................................. @ $ ,~__ Residencewiringover2000sq. ft .................................... @ $ __ Electric heat installation In existing residence ........................... @ $ SERVICES Temporary Construction Service ..................................... ~ $ ..... r- Service change only in an existing residence ........................... ~ $ Commercial or Industrial: __ Service not over 100 amperes ....................................... ~d~ $ ..... Service over 100 amperes but not more than 200 amperes ................. ~ $ __ Service over 200 amperes but not more than 400 amperes ................. (b? $ ...... Service aver 400 amperes but not more than 600 amperes ................. @ $ __ Service over 600 amperes ......................................... ~) $ ........ Service ever 600 volts ............................................. @ $ COMMERCIAL AND INDUSTRIAL FEEDERS Installation of Alterations or Relocation of Distribution Feeders: __ Notmorethan 100amperes ........................................ @ $ __ Over 100 amperes but not more than 200 amperes ....................... ~;~ $ __ Over 200 amperes but not more than 400 amperes ....................... ¢_~ $ _~__ Over400amperes ............................................... ~ $ __ Feederover600volts ............................................. ~_~ $ MISCELLANEOUS ...... A. Each trailer or mobile home apace (Service equipment) .................. ('cbS .__ B. Each supply for mobile home (Connection) ........................... ~ $ __ C, Each irrigation psmp (Attach a map showing location) ..................... ~i! $ __ D, Eacheleetricslgeoroutlinelighting ................................ ....... E. Each swimmingpool(bonding) ................................... (~ $ 80.00 BRANCH CIRCUITS __ One new circuit; alteration or extension ............................... ~b $ 20,00 ..... Tweormorenewcircuits;slterationsorextensione ....................... ¢_~$ 30.00 __ __ Other (as per NEC and Building Official) ......................................... __ On-Site Technical Review (apply directly at Marion County only) ...................... __ Industrial Plant Inspection (apply directly at Madoe County only) ...................... __ Relnspection Fee ................................................ (~ $ 20,00 FEE STATE SURCHARGE Please return COMPLETE APPLICATION PLAN REVIEW FEE 50.00 75.00 106.00 30.00 30.00 30.00 45.00 70,00 100,00 150,00 200.00 450,00 25.00 40,00 70,00 85,00 120.00 25,00 25.00 30,00 30,00 with the indicated fee, INVESTIGATION FEE FLEET SURCHARGETOTAL $ '~:~ t agree to make the electrical instafletion ac su~mit dp~ans~and~ifi~ati~ns~the~a~8~f~he~tate~f~re~nandt~e~rdinan¢e$~fMar~n~un~y' · - ~" (Supervising Electrelan) ......... [] HOMEOWNERS - I hereby certify that I am the owner of the property described above, at which location I propose to make an electrical installation for my own use and this property is eot being constructed for sale, lease or rent. 8~GNATURE OF APPLICANT;