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Received By <br /> <br />MARION COUNTY BUILDING iNSPECTION <br />Senator Bldg,, NO,, 225 <br />220 High Street NE <br /> <br />ELECTRICAL PERMIT APPLICATION <br /> <br />Site No <br /> <br />Phone <br /> <br />Mailing Address <br /> <br />Oross Street <br /> <br />Address:: <br /> <br />Sups rvising~_4~75 ec ricianX&.~¢~T <br />~lect rieal'Oont tact or s NO <br /> <br />Phone Addreas <br /> <br />Home Builde~;s Registration NO <br /> <br />Superv,sing Use of ~'sidential ~ New L~ <br />Electricians No :; Building Commercial ~ Alteration [] <br /> <br />Addition <br />Relocation <br /> <br />Occupancy <br />Change [] <br /> <br /> No, RESIDENTIAL <br />____ Residence wiring less than 1000 sq ft <br />..... Residence wiring less than ~.000 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 ever 200 amperes but not more than 400 amperes <br />__ Service over 400 amperes but not more than 600 amperes <br />___ Service over 600 amperes <br /> Service over 600 volts <br /> COMMERCIAL A"D NbusTRiAL <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 <br />__ Over 200 amperes but not more than 400 amperes <br /> Over 400 amperes <br />__ Feeder over 600 volts <br /> MISCELLANEOUS <br />__ A Each trailer or mobile home space (Service equipment) <br />....... B Each supply for mobile home (Oonnoctiom <br />__ C EaonirrigationpumptAttaohemapshow~ng[ocaticn) <br /> D Each electric sign or outline lighting <br />__ E Each swimming pooltbondm9~ <br /> SRANCH CIRCUITS <br /> One new circuit alteration or extension <br /> ,/_ Two or more new circuits= alterations or extensions <br />__ Other (aa per NEC and Building Official) <br /> On-Site Technical Review (apply directly at Marion County only) <br />__ Industrial Plant Inspection (apply dwectly at Mar~on County only) <br /> Reinspection Fee <br /> <br />Please return COMPLETE APPLICATION <br />with the indicated fee, <br /> <br /> 5O,,OO <br />7500 __ <br />10500 <br /> 3O 00 <br /> <br />30 00 <br />30 O0 <br /> <br /> 45 O0 <br /> 70 O0 <br />100 00 <br />150 O0 <br />20000 <br />450 00 <br /> <br /> 25 O0 <br /> 40 O0 <br /> 70 O0 <br /> 85 O0 <br />120 O0 <br /> <br />2500 <br />2500 <br />30 00 <br />3000 <br />3000 <br /> <br />2000 <br />3000 <br /> <br />2000 <br /> FEE <br /> <br />STATE SURCHARGE <br />PLAN REVIEW FEE <br />INVESTIGATION FEE <br />FLEET SURCHARGE <br /> <br /> TOTAL $-__ <br /> <br />I agree to make the electncal ~natallation a d~ o the subm~ lan ec~ficufior~s tho laces of the State of Oregon and the Ordinances of Marion Count~ <br /> <br />SIGNATUREOFAPPLICANT ~-'~'~' Job No: <br /> <br />f'-! HOMEOWNERS -,, I hereby certify that I am he owner of he proper y descr bed above, a which location I p.,ropase to make an electrical installation for <br /> my own use and th~$ property is not bain9 constructed for sale: lease or rent <br /> <br />SIGNATURE OF APPLICANT ...... <br /> <br /> <br />