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1aMAZON__ COUNTY BUILDING ~NSPECTION <br />RecelvedSy;_,.City ofAumsvil genatorBIdg. No.22g <br /> <br />Da e ........... ~,~2 .~J ~8 Salem, Oregon 97301 <br /> <br />ELECTRICAL PERMIT APPLICATION <br /> <br />Owner: Phone: Maitlng Address: <br /> Tom Doran 769-7364 P.O. Box ~85, Sublimity 97385 <br />Job Address: Site No,; erase Street: <br /> 900 N, 8ch Olney <br /> Phone: Address: <br /> <br />Electrlcel Firm; <br /> Sel£ <br /> <br />Supervising Electrician: <br /> <br />Electrical Contractor's No.: <br /> <br />Home Builder's Registration NO,; <br /> 55493 <br /> <br />Supervising Useof [ Residential ~ / New [~{ Addition E] Occupancy <br />Electrician%No,; Building: ResidencejLCommercial[] AlteratlonE3 Relocation ~] Change <br /> <br /> No. RESIDENTIAL <br />__ Residence wiring less than 1000 sq, ft ................................. (-~ $ <br />__ Residence wiring lees than 2000 sq. ft ................................. (~) $ <br />....... Residence wiring over 2000 sq. ft .................................... @ $ <br />.... Electric heat installation in existing residence ........................... 6! $ <br /> SERVICES <br />] Temporary Construction Service ..................................... ~; $ <br />__ Service change only in an existing residence ........................... ~ $ <br />Coromercial or Industrial: <br />Service not over 100 amperes ....................................... 6! $ $0.00 <br />.__ Service over 100 amperes but not more than 200 amperes ................. ~ $ 50,00 <br />__ Service over 200 amperes but not more than 400 amperes ................. aT $ 70.00 <br />...... Service over 400 amperes but not more than 600 amperes ................. @ $ 100,00 <br />__ ServlceoverB00amperes ......................................... 6) $ 130,00 <br />.......... Service over 600 volts ............................................. ~> $ 300.00 <br /> COMMERCIAL AND INDUSTRIAL FEEDERS <br />Installation of Alterations or Relocation of Distribution Feeders: <br />__ Not morethan 100amperes ........................................ L~ $ 20.00 <br />__ Over 100 amperes but not more than 200 amperes ....................... 6! $ 30,00 <br />.......... Over 200 amperes but not more than 400 amperes ....................... @$ 50.00 <br />__ Over400emperes ............................................... (aS 60,00 <br />__ FeederoverB00volts ............................................. (~?$ 80,00 <br /> MISCELLANEOUS <br />__ A. Each trailer or mobile home space (Serviceequ~pment) .................. @ $ 20.00 <br />__ B. Each supply for mobile home (Connection} ........................... @ $ ~0.00 <br />__ C. Each irrigation pump (Attach a mapshowingtocatlon) ..................... @ $ 20.00 <br />__ D. Each electric sign or outline lighting ................................ @ $ 20.00 <br />E. Each residential swlmm[ng pool .................................. .~. $ 20.00 <br /> BRANCH CIRCUITS <br />__ One new circuit: alteration or extension ............................... ('¢ $ 15.00 <br />Two or more new clrcuits; 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 />rndustrJal Plant Inspectlon (apply directly at Marion County only) ...................... <br />__ Reinepection Fee ................................................ @ $ 15,00 <br /> FEE <br /> STATE SURCHARGE <br />Please return COMPLETE APPLICATION PLAN REVIEW EEE <br />with the indicated fee. City ~ee IFS~T~G~E~E <br /> FLEET SURCHARGE <br /> TOTAL <br /> <br />30.00 <br />50,00 <br />70.00 <br />20.00 <br /> <br />20,00 S~2~.~O,, <br />20.00 <br /> <br /> ~.00 <br /> <br />LM HOMEOWNERS - I hereby certify t~at Iarg//n/c~ner of the property described above, at which location I propose to make an electrical installation for <br /> my own use and this proper~..~ tbe. ing~f,.~fit..~ed for sale, lease or rent. <br />S IG N AT, R E OF Ap *LiOA/~.~¢/""~-/.,,,~,~'~/..~/~'/ Y/~ , <br /> <br />Rev. 3/88 <br /> <br /> <br />