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Received By: Date: MARION COUNTY BUILDfNG INSRECTION Senator Bldg. NO. 225 220 High Street NE Salem. O~egon 97301 Phone 588-5147 Coae-A-Phone 4:30 RM. - 8:00 A.M. ELECTRICAL PERMIT APPLICATION pe Jsin,g t~tz",~"~l Useof Ele ct r ician $ N o./y~-"~C-'~j~(---,~ Building: Firm: ~ /ising ~e~zt*i~an: ' ~ Pho~'e~ ' Address: Residential [] ' New [] Addition [~ Occupancy Commemlal O Alteration [] Relocation [] Change NO. RESIDENTIAL ___ Residence wiring less than 1000 sq, ft ................................. @ $ __ Residence wiring less than 2000 sq. ft ................................. @ $ __.__ Residence wiring over 2000 sq. ft .................................... @ $ __ Electric heat instullatJon in existing residence ........................... @ $ SERVICES TempoYary Construction Service ......................... ~ $ ~ Service change only in an exicting residence ........................... @ $ Comrnerclal or Industrial: __ Service not o',~r 100 amperes ....................................... @ $ ___ Service over 100 amperes but not more than 200 ampem~ ................. @ $ -- Serviceoverg00arnperesbutnotmorethan400amperes ................. @ $ .... Service over 400 amperes but not more than 600 amperes ................. @ $ __ Serviceover600amperes ......................................... @ $ ,___ Se~vlceover600volts ............................................. ~-o~ $ COMMERCIAL AND INDUSTRIAL FEEDERS Installation of Alterations or Relocation of Distribution Feeders: __ Notrnomthanl00ampems ........................................ @$ 20.00 -- Overl00arnpereebutnotmorethang00ampeme ....................... @$ 30,00 -- Overg00amperesbutnctmorethan400amperes ....................... @$ 50.00 __ Over 400 amperes ............................................... @ $ 60.00 __ ....... FeederoverS00vctts ............................................. @ $ 80,00 MISCELLANEOUS __ A. Each trailer or mobile home space (Service equipment) .................. @ $ 20.00 __, B, Eachaupplyforrnnobilehome(gon~ectlor~) ........................... @$ g0.00 C, Each irrigation purnp (Atiach a map 8howirlg location) ..................... @ $ 20.00 __ D, Eachelectricsignoroutlinelighting ................................ @$ 20,00 .__ E. Each residentlal swimming pool .................................. ~() $ 20.00 BRANCH CIRCUITS -- OnenewcirouR;alterationora×tenslon ............................... @$ 15,00 -- TwoormorenewcJmuits;alterationsorexteneions ....................... @$ 20.00 __ --, Other (as per NEC and Building Offlcial) ......................................... -- On-Site Technical Revlew (apply directly at Marion County only) ...................... .... Industrial Plant Inspection (apply directly at Marion County only) ...................... __ ReJnebection Fee ................................................ @ $ 15,00 FEE STATE SURCHARGE Please return COMPLETE APPLICATION PLAN REVIEW FEE 30,00 80,00 70.00 20.00 20.00 20,00 30.00 50,00 70.00 100,00 130.00 300,00 with the indicated fee. iNVESTIGATION FEE TOTAL _ _ I agree to make the electrical in~all~tk!n ~6'o~in~to th~ 8~b~ltted p,a~s ~pecif,~atio~s,~he ,aws of tee Stere o~ O~ego~ and the O~inances of Mado~ Count. ~ HOMEOWNERS - I hereby Ce~J~ that I am the owner of the properl~e~cribed above, at which location I propose to make an electrical installation for my own use end this prope~ is not being constructed for sale, lease or rent. SIGNATURE OF APPLICANT: MC 15-34 ~,Owner doing h}s own we~k) Rev. 3,88