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,.~ ~ %~ ~.~ MARION COUNTY BUILI~ING INSPECTION <br />Received By ~,% ~'¢ ~ ~ Senato~Bldg,, No, 225 <br /> ~'~ ~ ~ .~ 220High~treetNE <br /> <br />Date ~X~ _ <br /> <br />DETROIT R~NGt~R DISTRICT <br /> <br />Job Address <br /> <br />, p~!,:~ozT BANG~ STA, ELD#2401 <br />Electrical Firm <br /> SULLIVAN ' S ~LE~I'~<IC CO <br /> <br />Phone:: <br /> 854-3366 <br /> <br />Site No :; <br /> <br />Phone:: <br />769-7124 <br /> <br />Mailing Address;; <br /> HC 60 BOX 320 MTLL CITY OR <br /> <br />Cross Street <br /> <br />Address <br />P.O.]~OX 417 STAYTON OR 97383 <br /> <br />Supervising Electrician Phone:: Address:: <br /> <br />El~'~l~;ocl'ra~C'~"TNO~--A~- Home Builder's Registration No:: <br /> <br />Supervising Useof I Residential ~ New ~ Addition ~ Occupancy <br />Electrician's No :; 1 336S Building L,Commercial ~ Alteration ~ Relocation ~ Change <br /> <br /> No, RESIDENTIAL <br />____ Residence wiring less than 1000 sq ft$ <br />___ Residence wiring less than 2000 sq ft ~:, $ <br />Residence wiring over 2000 sq ft (:~) $ <br />__ Electric heat installation in existing residence <br /> SERVICES <br />__ Temporary Construction Service (~:,$ <br />........ Service change only in an existing residence {¢~ $ <br />Commercial or Industrial: <br />.... Service not over 100 amperes ~) $ <br />__ Service over 100 amperes but not more than 200 amperes <br />Service over 200 amperes 0ut not more then 400 amperes <br />__ Service over 400 amperes but not more than 600 amperes ~ $ <br />____ Service over 600 amperes (Z:' $ <br />__ Service over 600 volts ¢~' $ <br /> COMMERCIAL AND INDUSTRIAL FEEDERS <br />Installation of Alterations or Relocation of Distribution Feeders:: <br />____ Net more than 100 amperes {i~ $ <br />Over 100 amperes but not more than 200 amperes ,~: $ <br />___ Over 200 amperes but not more than 4g0 amperes <br />__ Over 400 amperes <br />....... Feeder over 600 voRs f~= $ <br /> MISCELLANEOUS <br />__ A Eachtraderormob~iehomespeoe~Serviceequipmeml <br />........ B Each supply for mobile home tConnect~on) ~,$ <br />.... C Each irrigation pump (Attach a map showing location) ¢~ $ <br />__ O Eechelectricsignoroutlinelighting <br />__ E Each swimming pool fbonding) ~¢ $ <br /> BRANCH CIRCUITS <br />....... One new circuit alteration or extension (~i, $ <br />....... 7we or more new c rcu ts: a tara ocs or extorts ocs r?$ <br /> <br />50,00 <br />7500 <br />105 00 <br />3000 <br /> <br /> 30 00 <br /> 3O 00 <br /> <br />45 00 <br />7000 <br />100 00 <br />160 O0 <br />20000 <br />450 O0 <br /> <br />25 00 <br />40 00 <br />70 0O <br />85 00 <br />12000 <br /> <br /> 25,00 <br /> 2~ 00 <br /> 30 O0 <br /> 3000 <br /> 30.00 <br /> <br /> 20 00 <br /> 30 oo .................................. 3'0':"0'0 <br /> <br /> ...... Other (as per NEC and Building Official) ................... <br /> __ On-Site Technical Review tepply directly at Marion County onty) <br /> Industrial Plant Inspection tapply directly at Marion County only) <br /> __ Reinspection Poe (~t $ 20 00 <br /> FEE <br /> STATE SURCHARGE 1 . ~0 <br /> Please return COMPLETE APPLICATION PLAN REVIEW FEE <br /> w~th the indicated fee,, INVESTIGATION FEE <br /> FLEET SURCHARGE 8.--9-6 <br /> TOTAL $ <br /> $40.46 <br /> <br /> ~'7- fi% Job NO* <br /> · <br />HOMEOWNERS - I hereby certify that I am the owner of the property described above, 8t which location I propose to make an electrical installation for <br />my own use and th~$ property is not being constructed for sale: lease or rent <br /> <br />SIGNATURE OF APPLICANT <br /> <br />Rev 12/88 <br /> <br /> <br />