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~ '3 MARION C~[INTY BUILDING INSPECTION <br />Received By ,, Senator Bldg, NO,, 225 <br /> 220 High 8treat NE <br /> MARION COUNTY Salem, Omgo. ¢,3st <br />Date_ BUILDING iNSPECTION .ho.,so~s~4~ <br /> <br />ELECTRICAL PERMIT APPLICATION <br /> <br /> Phone:: Mailing Address;: <br />Farms 678-2755 14673 0ttoway N.E. Aurora, OR 9700; <br /> Site NO Cro~s'Street:: <br /> 99~, <br /> Phone Ad'~ss:: ...... <br /> 981-39~. P.0. Box 266. Hubb~a_r_~dL0__R 97032 <br /> Phoee:: Address:: <br /> <br /> ......... same same ......... <br /> Home Builder's Registration No <br /> 50829 <br /> Use of Residential [~ New El AdditiOn Q 0~c-upancy <br /> Building Commercial ~ Alteration F'f Relocation [~ Change [~ <br /> <br />Pacific Hazelnut <br /> <br />-J(~b Address <br />Same <br /> <br />Electrical Firm <br /> <br /> JR Electric <br /> <br />Supervising Electrician <br /> <br />Electrical Contractor's No <br />24-2050 <br /> <br />Supervising <br />Electrician's No 3138S <br /> <br /> No, RESIDENTIAL <br />____ Residence wiring Jess than 1000 eq, ft ~:' $ <br />.......... ResidenCe wiring lees than 20(]0 sq fl ..... (& $ <br />__ Residencewiringoverg000eq ft ...... (?'~:'$ <br />Electric heat instaflation in existing residence <br /> SERVICES <br />__ Temporary Construction Service ....... g_~ $ <br />Service change only in an existing residence (¢¢) $ <br />Commercial or Industrial: <br />__ Service not over 100 ~mperes ..... ~.) $ <br />3.__ Service over 100 amperes but not more than 200 amperes (~P $ <br />__ Service over 200 amperes but not more than 400 amperee <br />........ Service over 400 amperes but not more then 600 amperes (b~ $ <br />__ Service over 600 amperes ~_~' $ <br />__ Service over 600 volts ........ ¢i) $ <br /> COMMERCIAL AND INDUSTRIAL FEEDERS <br />Inetallation of Alterations or Relocation of Distribution Feeders: <br />..... Nolmore than 100 amperes .......... <br />__ Over 100 amperes but not more than ~00 amperes (h' $ <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 moPila home apace fService equipment) <br />,~__ B Each eupply for mobile home (Connection) ....... ('~' $ <br />__ O Each irdgatlon pump (Attach a map showlng location) .... <br />__ D Eachelectdesignoroutlinelighting <br />..... E Each swimming pool (bonding) (<~' $ <br /> BRANCH CIRCUITS <br /> <br /> 5000 __ <br /> 7500 <br />10500 <br /> 3000 <br /> <br /> ~0 00 <br /> 30gO <br /> <br />4500 <br />7O O0 70.0-0'- <br />100,00 <br />15000 <br />200 O0 <br />45000 <br /> <br /> 25 O0 <br /> 4O00 __ <br /> 70 00 <br /> 85 O0 __ <br />120 O0 <br /> <br /> ~5,,00 <br /> 2500 <br /> 30 O0 __ <br /> 30 O0 ...... <br /> 30 O0 <br /> <br />___ Other (as per NEC and Building Official) ...... <br />__ On-Site Technical Review (apply directly at Marion County only) <br />..... Industrial Plant Inspection (apply directly at Marion County only) <br />__ Reinspection Fee (si: $ 20 O0 <br /> FEE <br /> STATE SURCHARGE <br />Please return COMPLETE APPLICATION PLAN REVIEW FEE <br />with the indicated fee, INVESTIGATION FEE <br /> FLEET SURCHARGE ,, <br /> <br />7.68 <br />8.l, 18 <br /> <br />i agre~ to make the electrical mstallation according to the submitted plans and specifications, the laws of the state of Oregon end the Osdi~lances of Marion County <br /> <br />~ HOMEOWNERS - I hereby certify ~hat I am the owner of the proper~ described above: at which location I propose to make an electrical installation for <br /> my own USe and this property is not being constructed for sale lease or ren~ <br /> <br />SIGNATURE OF APPLICANT_ <br /> <br />MC 15-34 (Owner doing his own ~ork) <br />Rr~ 12/88 <br /> <br /> <br />