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~ ON COUNTer BUIi'DING INSPECTION <br />Received By: ]~\ I I.-)) SensOr Bldg. ~lo. 22s <br /> <br />Date: <br /> <br /> 5U:LDING iHS?E. CT!O:'~ <br /> ELECTRICAL PERMIT APPLICATION <br /> <br />Owner: " , / , ,~, ~ , Phone: Adc~ress; .... <br /> <br />Ele~rical Firm: Phone: ~dress: __ _ <br /> <br />8upe~ ~rician; · Phone: Address; ~ <br /> <br />Supervising "Use of ' New ~/ Addition 0 Occupancy <br /> <br /> No, RESIDENTIAL <br /> Residence wiring less than 1000 sq. ff ................................ @ $ <br />__ Residence wiring less than 2000 se. ff ................................. ~) $ <br /> Residence wiring over 20O0 sq. ff ........... <br /> Electric heat installation in existing residence,., i ii ii i i ii ii ii;; i;;; i ;;: ~ $$ <br /> SERVICES <br />__ Temporary Construction Service ..................................... @ $ 20.00 <br />__ Servlcechangeooly~nanexistingresidence .......................... @$ 20.00 <br /> Commercial or Industrial: <br /> Service not over 100 amperes ....................................... @ $ 30.00 <br /> Service over 100 amceres but net more than 200 amceras ................. @ $ 50.00 <br />__ Service over 200 amceres but not more than 400 amperes ................ @ $ 70,00 <br />__ Serviceover400ampsres0utnotrnorethan600amperes ................. @ $ 100.,00 <br /> Ssrviceover600amperes ......................................... @ $ 130.00 <br />__ Serviceover600volts ............................................. @ $ 300.00 <br /> COMMERCIAL AND INDUSTRIAL FEEDERS <br /> Installation of Alterations or Relocation o1 Distribution Feeders: <br /> NOt morethan 100 amperes ........................................ @ $ 20,00 <br /> Over 100 ameems but not more than 200 amperas ..................... @ $ 30,00 <br />__ Over200amperesbutnOtmorethan400amDeres ...................... @$ 50.00 <br /> Over 400 amperes ............................................... @ $ 60,00 <br /> Feederover600volts ............................................. @ $ 80.00 <br /> MISCELLANEOUS <br /> A. Eachtrailerormobilehomespsse(Servieeequipment) .................. @$ 20.00 <br /> S, Eachsupplyformobilehome(Conne~tlon).. ....... @$ 20-00 <br /> C. Each irrigation pump (At, ach a map showlnglocatlon) :, i i i i ii ii ii ii ii:: i: i C~. $ 20,00 <br /> D, Each electric sign or outline lighting ............................... @ $ 20.00 <br /> E. Each residential swimming pool .................................. @ $ 20.00 <br /> BRANCH CIRCUITS <br /> One new circuit: alteration or extension ............................... @$ 15,00 <br /> ./ TWO or more new circuits: alterations or extensions ....................... @ $ 20.00 <br />__ Other (as per NEC and Building 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 ....................................................... <br /> FEE <br /> STATE SURCHARGE <br />Please return COMPLETE APPLICATION PLAN REVIEW FEE <br /> INVESTIGATION FEE <br />with the indicated fee: FLEET SURCHARGE <br /> TOTAL <br /> <br />30,00 <br />50.00 <br />70.00 <br />20.00 <br /> <br />ageetomake heoectroa instellationaccor ngtothesubmltte~plansenospecifications thelawsofthe~ta~ofOmgonandtheO~lnan~sofMe~onCoun~. <br />SIGNATURE OF APPLICANT:~ ~ ~ <br />~ HOMEOWNERS - I h~ ~ described abo~, at which location I propose to make an electrical installation for <br /> my own use and thi~ pmper~ is not being constru~ed for sale. lease or rant, <br /> <br />SIGNATURE OF APPLICAN~ ,, <br /> <br />MC 1~-34 <br /> Rev, 3/87 <br /> <br /> <br />