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P/ease mmp/e~//CE~ns, I through 5
<br />
<br /> Salem, Oregon 97301
<br />
<br />Phone 588-5147 8,00 a.m, - 4:~O p,m,
<br />FAX: 588-?948
<br />
<br />1, LOCA'nON OF IN~TAM.A'RON
<br />
<br />JobAddress 94-9=3 P~)RTER ROAD
<br />cra,, AUMSVILLE ] Cro~ st,,
<br />
<br />Dlrm:tlons: MAP ENCLOSED
<br />
<br />Description::
<br />
<br /> ,. c
<br />
<br />Electrical Oontrs~lor F R A H L E R E L E C T R I C C 0 .
<br />
<br />Mailing Address 11860 SW ~URG, ZJ~- 0P
<br />
<br />Pmpe~ Owner
<br />
<br /> 34-13~,
<br /> Contractor"s Board Reg. No,, 3 7 4 1 0, ] Job No,, 4 9 5 7 9
<br />"Signature ef Supervising Elactrlclan/~.k? ~
<br /> Supervisors License No~ 1 8 1 6~ I Phone No, 6 3 9 - ~ 6 2 7
<br />
<br />2B, FOR OWNER ~-'TALLA'I1ON~
<br />Property Owner
<br />
<br />Mailing Address ~. I Phone
<br />
<br />City/$mte/Zip
<br />
<br />The installation Is being made on property I own which is not intended for sale,
<br />lease or rent,
<br />
<br />Owner"s Signature
<br />
<br />PLAN REVIEW SECI10N
<br /> Check ~ata item ar~l en~r fee in SeclJon SB.
<br />
<br /> Connected Load over 200 amps (except single family dwellings)
<br /> Building system over 200 amps (except single family dwellings)
<br /> System over 600 volts
<br /> Building ever 2 stories
<br /> Building ever 10=000 square feet
<br /> Occupant load over ~OO persons
<br /> Manufectered Dwelling PaddRecmetian Park
<br /> Hazardous Locations
<br />
<br />Submit 2 sets of plans with any of I~e above,,
<br />Temporary construction services do not apply,,
<br />
<br />Mc t6.34 Rev,
<br />
<br />SITE #: Permit No,,
<br />Date:
<br />Issued by::
<br />
<br />4, FEE SCHEDULE (Complete and enter teml in At below)
<br />Number of In~peeflons per permit ellowed
<br />
<br />A. ReeldenUel, Single or Iteme x Cost; Total
<br />
<br />Multi-Family per dwelling unit
<br />($erv~-e in~uded)
<br />
<br /> 1500 sq, fl, o~lesm
<br /> Eamh m~d'l ~o ~ a. or por~n
<br /> E~h Mfg/d Ho~ or M~u~r
<br /> D~lling ~ or ~r
<br />
<br />B. ~wlc~e~ers
<br />(fO Br~ Ol~ ~)
<br />
<br /> 100a~or~
<br />
<br /> ~er 1~o
<br /> R~nn~Only
<br />
<br />~ Tem~w ~w~e~F~era
<br />
<br /> ~ar ~
<br />D. Bmn~h
<br />
<br /> One elmug
<br /> Two ~
<br />
<br />[ ~s~ltsneous
<br />
<br /> ~ pe~ or Ir~ge~on
<br /> E~ s~n ~ outline Ilgh~ng
<br /> SlgnN clmult(s) or a Ilml~ enemy
<br />
<br />F, E~h add'l las~e~co
<br /> ~er ~ ~l~le In any
<br />
<br />G. Mlaor Ins~ltsflon ~la
<br />
<br />$ 15.__
<br />
<br /> '[ $36,,
<br />__$60,
<br />__$80.
<br /> $1~O.
<br />
<br />__$36,
<br />
<br />35.00
<br />
<br />At ,, Enter total of fees~ fr~Jm Sec. #4
<br />AC. Add 5% t~tcheJ~le (,05 x Al)
<br />
<br /> Subtotal
<br />
<br />B, Enter P..5% ofline A~ f~- Plan Review
<br /> (Sec. $), if mquirl~d
<br />C. Invesifgallan Fee (if requirad)
<br />D. Reinr~on Fee ($25,o0)
<br />
<br /> TOTAL AMOU~NT DUE
<br />
<br />2
<br />2
<br />2
<br />2
<br />2
<br />
<br />$36, 2
<br />$so, qO.O0 e
<br />$15. 2
<br />
<br />$36. 2
<br />
<br />$!5 .oo
<br />$
<br />
<br />$89.25
<br />
<br />
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