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Received By: <br />Date;. <br /> <br />M/~RIOI~OUNTY BUILDING INSPECTION <br />Senator Blag. NO. 225 <br />220 Higa St~ NE <br /> Salem, Oregon 97301 <br /> <br /> Phone $88-5147 <br /> Code-A-Phone 4:30 RM, - 8:00 A,M. <br /> <br />ELECTRICAL PERMIT APPLICATION <br /> <br />' ...... <br /> <br />j~ mar; ~. ........................... Phone: Mailing Address: <br /> <br />_ ~. ~ ~,' __ ~ite No.; ~c.~~ <br /> Home ~Tist rati°n "°-: <br /> Supervising i /,~0/ IUseOf I Reside,rial ~ I New ~ Addition = Occupa,cy <br /> Electdcian~No,:~ Building: Commemial ~ Alteration~ Relocation ~ Change <br /> <br /> NO, RESIDENTIAL <br /> Residence wiring less than 1000 sq. ft ................................. ~ $ 50,00 <br />__ Rasidencewiringlessthan2000sq. ft ................................. @$ 75.00 <br /> Residence wiring over 2000 sq. ft .................................... ~__ $ 105.00 <br />__ Electric heat [nstatlation in existing residence ........................... (q~ $ 30.00 <br /> SERVICES <br /> Temporary Construction Service ..................................... Cz) $ 30.00 <br />__ Service change only in an existing residence ........................... ~ $ 30.00 <br /> Commercial or Industrial: <br />...... Service not over 100 amperes ....................................... ¢~3 $ 45.00 <br />__ Servlceoverl00amperesbutnotmorethan200arnperes ................. @$ 70.00 <br />__ Service over 200 amperes but not mom than 400 amperes ................. ~ $ 100.00 <br />__ Service over 400 amperes but not more than 600 amperes ................. @ $ 150,00 <br />__ Serviceover600amperes ......................................... @~ $ 200.00 <br />__ Serviceover600volts ............................................. @ $ 450.00 <br /> COMMERCIAL AND INDUSTRIAL FEEDERS <br /> Installation of Alterations or Relocation of Distribution Feeders: <br />__ Not morethan 100amperes ........................................ (~ $ 25.00 <br />____ Over 100 amperes but not more than 200 amperes ....................... (¢ $ 40.00 __ <br />__ Over 200 amperes but not more than 400 amperes ....................... @~ $ 70.00 <br />__ Over400amperes ............................................... ~)$ 85,00 <br />...... Feeder over 600 volts ............................................. ('¢$ 120,00 <br /> MISCELLANEOUS <br />__ A, Eachtrailerorrnobilehomespace($erviceequipment) .................. @$ ~5.00 <br />__._ B. Eachsupplyformebllehome(Oonnection) ........................... (¢__$ 25.00 <br />__ O. Eaehlrrlgatlonpump(Attacbamapshowinglocation) ..................... (~$ 30.00 <br />__ D. Each electric sign or outline lighting ................................ C_¢ $ .30.00 <br />__ E, Each swimming pool (bondlng) ................................... (~ $ 30.00 <br /> BRANCH CIRCUITS <br />__ One new clrcult;alteration or extension ............................... @ $ ~0.00 __ <br />__ Twoorrnorenewcircults;alteratlonsorextensions ....................... (~$ 30.00 <br />__._ Other (as per NEC and Building Official) ......................................... <br />__ On-Site Technical Review (apply directly at Marlon County only) ...................... <br />__ Industrial Plant Inspection (apply dlrectly at Marion County only) ...................... <br />.__ Reinspection Fee ................................................ @ $ 20.00 <br /> FEE <br /> STATE SURCHARGE __ <br />Please return COMPLETE APPLICATION PLAN REVIEW FEE <br />with the indicated fee. INVESTIGATION FEE <br /> FLEET SURCHARGE <br /> TOTAL <br /> <br />$fGNATU R E OF AP RLICAN3~I agree to make the electrical ins ~ .~j~llati°n lng to_ t he submitted pla r~d~specificati~/~~s, the laws of the State of Oregon end the O~dinances of Madon County.~o~) ~o, <br /> I/ <br /> (SuPervlslhg Electrician) <br />[] HOMEOWNERS - I hereby certify that I am the owner of the prope'~y described above, at which location I propose to make an electrical installatlon for <br /> my own use and this preperty is not being constructed for sale, lease or rent, <br /> <br />SIGNATURE OF APPLICANT: <br /> <br /> <br />