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ReceivedSy:~ ~> II [~.~JJ ~nl~t~laglNO122JJ <br /> ~' ~( " ~ 220.High Stm~ NE <br /> <br />Date; <br /> ~/ ~, ..... ~' Phone 588~1~7 <br /> <br /> ~B[LB[~ [~RICAL PERMIT APPLICATION <br /> <br />..... Phone; ' I Mailing Address: ...... <br /> <br /> .... ~: ICress Street: <br /> ~one: Address: <br /> Phone', Address; <br /> <br />Home ~ui~der~ Registration No,: <br />~uiid~ng:~ ~~m~rci~l ~ A~temtion ~ Re[ocat[o~ ~ Cha~ge <br /> <br />Job Address: <br /> <br />Electrical Firm: <br /> <br /> No. RESIDENTIAL <br /> __ Residence wiring ressthan 1000 sq. ft ................................. ~1 $ 30.00 <br /> ~ Residence wiring less than ~f000 sq, ft ................................. <br /> Residence wiring over :~000 sq, f~ .................................... (',~ $ 70,(30 <br /> ___ Electric heat installation in existing residence ........................... ~; $ 20.00 <br /> SERVICES <br /> .... TemporaryConstructionService ..................................... (~ $ 20.00 <br /> __ Servicechaegeonlyinanexistingresidence ........................... ¢_¢$ 20,00 <br /> Corn martial or Industrial: <br /> __ Servicenotoverl00amperes ....................................... ~>$ 30,00 <br /> ~ Service over 100 amperes but not mom than 200 amperes ................. @? $ 50.00 <br /> .... Sewic~ over 200 amperes but not more than 400 amperes ................. @ $ 70.00 <br /> __ Service over 400 amperes but not more than 600 amperes ................. C¢$ 100,00 <br /> .... Sarviceover 600amperes ......................................... @ $ 130,00 <br /> __ Service over 8go volts ............................................. (~) $ 300.(30 <br /> COMMERCIAl, AND INDUSTRIAL FEEDERS <br /> Installation of Alterations or Relocation of Distribution Feeders: <br /> Not more than 100 amperes ........................................ <br /> ..... Over 100 amperes but not more than 200 amperes ....................... ¢;! $ 30.00 <br /> __ Over20OamperesbutnotmoreIhae400amperes ....................... @$ 50,00 <br /> __ Over400amperes ............................................... (¢ $ 60,00 <br /> __ Feederever600voIts ............................................. @$ 80,00 <br /> MISCELLANEOUS <br /> __ A. Eachtrailerormobilehomespace($ervicesquipmsnt) .................. ~)$ 20.00 <br /> ..... B. Each supply for mobile home (Conns~fion) ........................... ('~ $ 20.00 <br /> __ C. Each irrigation pemp (A11ach a map showing Ioo~ion) ..................... ~) $ ')(3,00 <br /> __ D. Each electric sign or outlinelighting ................................ @ $ 20.00 <br /> ,~ E. Each residential swimming p0ol .................................. ¢!7 $ 20.00 <br /> BRANCH CIRCUITS <br /> __ Onenewcircuit;artarationorextenslon ............................... ~$ 15.00 <br /> ___ TWO or more new cimuits; alterations or extensions ....................... ~) $ 20,00 <br /> Other (as per NEC and Building Offlcial) ......................................... <br /> On- $ite Technical Review (apply directJy at Marion County enly) ...................... <br /> _,,__ Industrial Plant inspection (apply directly at Me~rion County crt[y) ...................... <br /> ReinspectJ0n Fee ................................................ ~¢. $ 15.00 <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 />I agree to make the ele6t rtcal installation sccording to the submitted plans and specifications, the laws of the Stats of Oregon and the Ordinances of Marion Count, <br /> <br />SIGNATURE OF APPLICANT; <br /> <br /> HOMEOWNERS - I hereby ceitify that I am the owner of the~g..roperty described above, at which location I propose to make an electrical installation for <br /> myown use and this property ,s not bei/ncc~o nstr u ct ed fo~,,~f-e, I~e,~e~or re nt. <br /> <br />MC;1534- ~ ~ ~'~"I'~. {Ownurdoinghisownwork) <br /> <br /> <br />