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IL :j MARION COUNTY BUILDING INSPECTION <br />Rec( S~nator Bldg. NO, 225 <br />JUL. g?, <br /> <br /> e~ ~& ~,~ ~{~ ELE~RIC~LPERMiTAPPMCATION <br /> <br />Ow[~e'r: ' ............ Phone: Address: <br />Situs Address: Site No,: Cross Street: <br />Electrical Firm: Phone: Address: <br />J~SON'$ 'rNc. 363~4141 p.o. Box 12669 Salem, OR 97309 <br />Supervising Electrician: Phone: Address: <br />Don Kuhl same same <br />Electricst Contractor's' No.: Home Builder's Registration NO.: <br />24-18c 34604 <br />SuperviSing ' ........................ Use of New [] Addition [] 0cc'~J'p~ncy <br />Electrician's No,: 1369-S Building: Ateratonr~ Relocation [] Change [] <br /> <br /> No. RESIDENTIAL <br />__ Residence w;ring less than 1000 sq. ft ................. ................ @ $ 30.00 <br />__ Re$idencewiringlessthan2000sq. ff ................................. @$ 50-00 <br />__, Res~dencewidngover2000sq. ft .................................... @$ 70.00 <br />__ Electric heaticetstlation in existing residence ............ · ............... @ $ 20,00 <br /> SERVICES <br /> / Temporary Construction Service ................................... i. @ $ 20.00 <br /> Service change only in an existing residence ........................... @ $ 20.00 <br /> Commercial or Industrial: <br /> Service not over 100 amperes ....................................... @ $ 30.00 ' <br />__ Service over 100 amperes but not more than 200 amperes ................. @ $ 50.0g <br />__ Service over 200 amperes but not more than 400 amperes ................. @ $ 70,00 <br />__ Service over 400 amperes but not more than 600 amperes ................. @ $ 100.00 <br />__ Servlceover600amperee .................. ...................... , @ $ 13o,oo <br />__ Serviceover600volts ............................................. @ $ 300,00 <br /> COMMERCIAL AND INDUSTRIAL FEEDERS <br /> Installation of Alterations or Relocation of Distribution Feeders; <br />__ Notmorethanl0Oamperes ........................................ @$ 20,00 <br />__ Over 100 amperes but not more than 200 amperes ....................... @ $ 30.00 <br />__ Over 200 amperes but not more than 400 amperes .............; ,, ....... @ $ 50,00 <br />__ Over400amperes .................. ;; ................... ...... .,@$ 60.00 <br />__ Eeederover6OOvoRs ............................................. @ $ 80,00 <br /> MISCELLANEOUS <br />__ A. Eachtrailerormobilehomespace(Servieeequipment) .................. @$ 20.00 <br />__ B, Eechsupplyformobilehome(Oonnection) . .......................... @ $ <br />__ C. EBchirrigationpump(Attachsmapshowlnglocation) ..... ........ ........ @ $ 20.00 <br />__ D, Eachelectrlcsignoroutlinelighting .......................... ; ..... @ $ 20.00 <br />__: E. Each residential swimming po01 ........ ........, ~. ~... ~ .... .; ..;.. @ $ 20.00 <br /> BRANCH C RCU T~ <br />__ One new cimoit; alteration or extension ............................... @ $ 15,00 <br />__. Twoormorenewcimuits;alteratlonsorextensions ....................... @$ 20.00 <br />__ Other (as per NEC and Boilding Official) ......................................... <br /> On-Site Technical Review (apply directly at Marion County only) ................ ...... <br />__ Industrial Plant Inspection (apply directly at Marion County only) ...................... <br />__ Reinspectlon Fee ........................................................... <br /> FEE <br /> STATE SURCHARGE <br /> <br /> Please return COMPLETE APPLICATION PLAN REVIEW FEE <br /> with the indicated fee. INVESTIGATION FEE <br /> FLEET SURCHARGE ~ <br /> TOTAL <br /> <br />agree to ma~e the ele~rical i I~ ~ the StYe Of Oregon and the O~insn~8 of Marion Coup. <br />$]GNATUREOFAPPLICAN~~ ~ ~ ~~ <br /> HOMEOWNERS - I hereby co~l~ that I ~m the ~ner of the proper~ de~ribsq above; at which 10cati0n t propose to make an ele~dcal Installation for <br /> my own uce and this p~pe~ is n~ being ~n~ru~ed for sale, Ieee or tent, <br /> <br />SIGNATURE OF APPLICANT; <br /> <br />(Owner doing his own work} <br /> <br />MC 15-34 <br />Rev. 3/87 <br /> <br /> <br />