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M~ON ~OUNTY BUILDING INSPECTION <br /> Senator Bldg. No, 22S <br /> 220 High Stroot NE <br /> Salem, Oregon 97301 <br /> <br /> Phone 588-g147 <br /> <br /> Code-A-Phono 4;:30 PM. - S:00 A.M <br /> <br /> ELECTRICAL PERMIT APPLICATION <br /> O~ner ....... ~ Phone ~iling Address <br /> <br />..... l ©,',-,_ d ~' <br />Jsb Address ~ ..... ~ ~i-te No Cross Street <br /> <br /> Supervising Electrician Phone Address <br /> <br />Home Builder% Registration No :: <br /> <br />Supervising .... -Useof Residential f~ . New <br /> ] AlteratiOn <br /> merciai ~ <br />Elecmcian's No Bs4ding:: <br /> <br />Addition [~ Occupancy <br />Relocation [~ Chsnge <br /> <br /> No RESIDENTIAL <br /> Residence wiring less than 1000 Sq ft <br />.... / Residence wiring legs than 2000 sq ft <br />..... Residence wiring over 2000 sq ft <br /> .... Electric heat installatiot~ in existed§ residence <br /> SERVICES <br /> Temporary Constructioe Service <br /> .... Service change only in an e×istin9 residence <br /> Commercial or Industrial: <br />...... Service not over tO0 amperes <br /> .... Service over 100 amperes but n0f more than 200 amperes <br /> Service over 200 arr~peres but not more than 400 amperes <br /> Service over 400 amperes but n0t more than 600 amperes <br /> __ Serwco over 600 amperes <br /> Sar'doe over 600 volts <br /> COMMERCIAL ,AND INDusTRIAL FEEDERS <br /> Installation of Alterations or Relocation of Distribution Feeders: <br /> Net more th~n 100 amperes <br /> ....... Over 100 amperes but ecl more than 200 amperes <br /> O~er 200 amperes but not more than 400 amperes <br /> __ Over 400 amperes <br /> Feeder ovor 600 volts <br /> MISCELLANEOU$; <br />A Each tr~Slar or mobile home space [Serried ~.~qt~pment <br />.... B Each supply for mobile home (Oonnec~ic~ <br />C Each Irligation pump {Attach u map Showing Iocatiun) <br />D Each eloctric sign or euthne lighting <br />..... E Each swrhming pool(bonding) <br /> B R'ANCH CIRCUITS <br /> One ~ew circuit ~lteration or extension <br /> Two or more sew c~rcuits alferati0ee or extensions <br /> Other/as per NEC and 8~ildm§ Official) <br /> ...... On ,Site Techni~sl Review (apply directly at Marion County only! <br /> Industrial Plahf Inspection (app{y directly at Madon County only) <br /> Retrospection Fee <br /> <br />Please return COMPLETE APPLICATION <br /> <br /> 50 oo <br /> 75 oo <br />105 oo <br /> 30 00 <br /> <br />3000 <br />30 oo <br /> <br />15000 <br />20000 <br />450 O0 <br /> <br />45 O0 __ <br />70 O0 <br /> <br />(h, $ 05 00 <br />(., $ 40 00 <br />er $ 70 00 <br />9~ $ 85 00 __ <br />r~4: $ 120 00 <br /> <br />~:~ $ 2500 <br />i~, $ 2.500 __ <br />f<, $ 30 00 <br />S~ $ 30 O0 <br />S, $ 3000 <br /> <br />r~, $ 20 00 <br />(~ $ 30 00 <br /> <br /> rf~ $ 20 00 <br /> FEE <br />STATE SURCHARGE <br />PLAN REVIEW FEE <br /> <br /> INVESTIGAT ON FEE . <br /> with the indicated fee FLEETSURCHARGE ~ <br /> //] TOTAL ~$ _(~¢'~77~ <br /> <br />I I HOMEOWNERS - I hereby <~ertify that I am the owner of the property described above, at which location I propose to make an electrical it~sfallahon far <br /> my own use snd th~s property fs not bern9 constructed for sale, fe~se or rent <br /> <br />SIGNATURE OF Apel ,ICANT __ <br /> <br /> <br />