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Received By: Date; MARION couNTy BUILDING INSPECTION ~enetor Bldg. NO. 225 220 .High Street NE -~ Salem, Oregon 97301 PllO~le 588-5147 Code-A-Phone 4:30 RM, - 8:00 A.M. ELECTRICAL PERMIT APPLICATION ~;~.~ Phone: Mailing Address: ,~rm: Phone: Address: ql Electrician'. ,, · Phon~: Address: ;onfractor's NO.: ! Home B,,ilder's Registration NO. '. g Use of Residential -I];]--"~Jew [] Addition [] Occupancy _s~ Building: Ceremonial [] Job Address: Supervising Electrician's N No. RESIDENTIAL __ Residence wiring less than 1000 sq. ft ................................. @? $ 50,00 __ Res[dencewirlng lessthan 2000 sq, ft ................................. @ $ 75.00 __ __ Resldencewiringoverg000sq, ft .................................... @$ 105.00 __ Electric heat Installation in existing residence ........................... @ $ 30,00 SERVICES Temporary Construction Service ..................................... (~. $ 30.00 7""-- Servicechangeonlyinanexistlngresidence ........................... @$ 30.00 Commemlsl or Industrial: __ Service not over 100amperes ....................................... @ $ 45.00 __ ___ Service over 100 amperes but not more than 200 amperes ................. (q~ $ 70.00 -- Serviceover2g0amperesbutnotmorethan400amperes ................. @$ 100.00 __ __ Serviceover400emperesbutnotmorethanG00amperes ................. (a? $ 150.00 ..... ServlcsoverG00amperes ......................................... @ $ 200.00 __ ServiceoverG00volts ............................................. @ $ 450.00 COMMERCIAL AND INDUSTRIAL FEEDERS Installation of Alterations or Relocation of Distribution Feeders: __ Netmorethan 100amperes ........................................ @ $ 25,00 __ Over 100 amperes but not mere than 200 amperes ....................... @ $ 40.00 ___ Over2OOemperesbutnotmorethan4OOarnperes ....................... @$ 70,00 __ Over 400 amperes ............................................... (¢ $ 85.00 __ FeederoverGOOvolts ............................................. @ $ 120.00 MISCELLANEOUS __ A. Each trailer or mobile home space (Service equicmenb .................. ~/ $ 25.00 ,:. ) .... B. Each supplyfor mobilehome(Connection) ........................... @ $ 25.00 C. Eechirrigationpump{Attachamapshowinglocation) ........ ~ ............. ~$ 30.00 ''~'"' D. Eachslectdcsignoroutlinelighting @$ 30.00 · :..'. __ E, Each swimming pool (bonding) ................................... ((i~ $ 30.00 BRANCH CIRCUITS .... One new circuit; alteration er e×tension ............................... ~i~$ 20.00 -- Twoormorenswclrcuits;alterationsorextensiocs ....................... @$ 30,00 Other (es per NEC and Building Offlcial) ......................................... -- On-Site Technical Review (apply directly at Marion County only) ...................... __ Industrlst Plant Inspection (apply directly et Marion County only) ...................... __ Reinspection Fee ................................................ ~.~ $ 20.00 FEE STATE SURCHARGE Please return COMPLETE APPLICATION PLAN REVIEW FEE with the indicated fee, INVESTIGATION FEE FLEET SURCHARGE TOTAL I agree to make the electrical installation a in submie plans and specifi¢stion8, the laws of the State of Oregon and the Ordinances of Marion County. ~ g~ ~D- I 6~0 Job No: ~ HOMEOWNERS - I ~emby certi~ that I am the owner of the property described above, at which location I p~pose to make an electrical Installetion for my own use and this property is not being constructed for sale, lease or rent. SIGNATURE OF APPLICANT:__