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Received By: <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br />Senator Bldg, No. 22ti <br />220 High Street NE <br /> Salem, Oregon 97301 <br /> <br /> Phone SS8-~147 <br /> Code-A.Phone 4:3e RM, - s=oe A,M, <br /> <br />ELECTRICAL PERMIT APPLICATION <br /> <br /> Mailing Address; <br /> <br />Job Address'. Site No.: <br />Electrical Firm: Phone: <br />Supervising EiectricT&n: Phone: <br /> <br />E{eotrlcal Contractor's No.: <br /> <br />Supervising Useot "~sideDtial ~ New <br />Eleo:dclen'~ No.: / ~'~ ~. $ Building: ~. ~-~:D _ CommeF0ial-- Alteration <br /> <br /> No, RESIDENTIAL <br /> ResJdenoe wiring less than 100g sg. ft ................................. <br /> ____ Residence wiring ~ess then 2000 sq. tt ............ <br /> __ Residenoe wiring over 2000 scl ft .................................... <br /> <br /> SERVICES <br /> Temporary Construction Service ..................................... CcC <br /> __ Service change only in an existing residence ........................... (4~ <br /> ~ Commen~ial or Industrial: <br /> Servise not over 100 amperes ....................................... <br /> ~ ~ervice over 100 amperes but not more than 200 amperes ................. ~i~ <br /> -- Service over g00 amperes but not more than 400 amperes ................. (ih <br /> <br /> __ Service over 600 amperes ......................................... ~ <br /> __ Service over 500 volts ............................................. ~ <br /> COMMERCIAL AND INDUSTRIAL FEEDERS <br /> Installation of Alterations or Relocation of Distribution Feeders: <br /> ~_ Not more then 100amperes ........................................ <br /> Over 100 amperes but not more than 200 amperes ....................... 2_~:, <br /> Over 200 amperes but not more than 400 amperes (~-~ <br /> ........ Over 400 amperes ............................................... (_(~ <br /> __ Feeder over 600 volts ............................................. (~ <br /> MISCELLANEOUS <br /> <br />Cross Street; <br /> <br />Address: <br /> <br />Address; <br /> <br /> 50.00 <br />75,00 __ <br />105.00 <br /> 30,00 <br /> <br />30,00 <br />30,00 <br /> <br />Home Builder~ Registration No.; <br /> <br /> 45.00 __ <br /> 70,00 <br />100,00 <br />150.00 <br />200.00 __ <br />450,00 <br /> <br />Addition [] Occupancy <br />Relocation [] Change [] <br /> <br /> 25.00 <br /> 40,00 <br /> 70.00 <br /> 85,00 <br />120.00 <br /> <br />__ A, Each trailer or mobile home space (Service equipment) .................. (~z, $ 25,00 <br />...... B. Each supplyfor mobile home (Connection) ........................... _¢1 $ 25,00 <br />__ C, Each irrigation pump IA~tac~ amap showinglocation) ................... ,', ~ $ 30.00 <br />...... ;. D. Eacheleotricsignoroutlinefightlng ................................ ({i~$ 80,00 <br />E. Eachswimmingpool(bonding) ................................... ¢~$ 30,00 <br /> BRANCH CIRCUITS <br /> <br /> One new circuit; alteration or extension ............................... (¢' $ 20,00 <br /> Two or more new circuits; alterations or exrensions ....................... (~., $ 30,00 <br /> Other (as per NSC and Suilding Official) ......................................... <br /> -- On-Site Technical Review (apply directly at Marion County only) ...................... <br /> ....... Industrial Plant Inspection (apply directly at Marion County only) ...................... <br /> __ Reinspection Fee ................................................ (~? $ 20,00 __ <br /> FEE ~ e. <br /> STATE SURCHARGE 4/, ~ <br /> Please return COMPLETE APPLICATION PLAN REVIEW FEE <br /> with the indicated fee, INVESTIGATION FEE <br /> FLEET SURCHARGE <br /> TOTAL <br />SIGNATU R, 0 F AP P LICANT,.~I agreeto mago the eleotrical Ino .¢~ he submitte¢.' /~' d Inns and specifications, t heiaws[ofiheStateo~ Ore[~o n~(sup¢ rv '' ingErectfl< lan and the Ordinances of~_o~oMarion ]~oC°U n.t y.. <br />LJ 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 <br /> my own use¢ and this property is not being constructed for sale, lease or rent, <br /> <br />SIGNATURE OP APPLICANT: <br /> <br />Rev. 12/88 <br /> <br /> <br />