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Received by:, <br /> <br />MARION COUNTY Big[LDING <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, 1 through 5 <br /> <br /> 220 High Street NE <br /> Salem, Oregon 97301 <br /> <br />Phone 558-5147 8:00 am - 4:30pm <br />Code-A-Phco~: 588-7904 <br /> FAX: 558-7948 <br /> <br />L LOCATION OF INSTALLATION <br /> <br />JobAddre~s 13269 DAIQUIRI LAKE DRIVE <br />City AUROKA ~ Cr~s ~t <br /> <br />I~sedpaonPUBLIC WORKS AND UTILITIES BUILDINGS <br /> 400A 240V SERVICE <br /> <br />PERMfi~ ARE NON.'IRANSFERABLE AND NON.REFUNDABLE AND <br />EXI~.E IF WORK IS NOT STARTED W1TH]N 180 DAYS OF ISSUANCE <br />OR IF WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLy <br /> <br />Electrical Contractor CHRIS TEN S 0N ELECTRt~hone 503-241-48 l <br />]Vhi~ngAddm~s 111 SW COLUMBIA,SUITE 480 PORTLAND,C~ <br /> <br />P~I~r~y Owner [ Phone <br />Contmctoe~ Li~mse No. 26-34C <br />Contr~ctoe~ B~d Re~. No. 00458 [ lob No. 407-2930 <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br />Property Owner <br />MaiEng Address ' Phone <br />Ci~y/$tatefZip <br /> <br />The in~tallafion is being mad~ on pro~ rgy I own which is not intended for sale, <br /> <br />Ownef~ Signature <br /> <br />3. PLAN RE¥1EW SECTION <br /> <br />We will provide plan review service if you complete Section <br />5B and submit two (2) sets of plans and specifications with <br />this application. <br /> <br /> This Optional plan review program does not suspend the <br /> required submission of lighting power calculations, plans. <br /> and specifications when required by the Oregon S~uctural <br /> Specialty Code, Chapter 53. <br /> <br />MC 15-34 H/gI <br /> <br />~20 <br /> <br /> Issued by: <br />EXISTING PERMIT 42429 <br /> <br />4. I~E SCHEDULE (Complete and enter total in A 1 I~low) <br /> <br /> Number of Inspections pe~ permit allowed <br /> <br />A. Residential Per Unit <br />Service Included: Ill, IS COSt (each) Sum/ <br /> <br /> 1000 sq, f~ or less - $85.00 <br /> Each additional 500 ~q. ft. <br /> orpom('m ~r~of $15,00 <br /> Limltc~l Energy $20,00 __ <br />Each Manufd Ho~e or M~brlar <br />Dwelling Service ct Feeder $40.00 __ <br /> <br />B, Services or Feeders (Does not inleude branch ~rcult% see seetiofl D) <br /> Inst~llatten, Alte~attenS Or RelOcation <br /> <br /> ~00 amps or less 50.00 <br /> 4O0 ...... o,00 6o. 0 <br /> 401 amps to 6O0 amps $100.00 __ 2 <br /> I~01 aml~ to 1000 amps $130,00 -- 2 <br /> Over 1000 amps or volt~ $300,00 2 <br /> Reconnect only $40,00 __ <br /> <br />C. Temporary Servlce~Feeders <br /> <br /> 200 amps or less $35.00 <br /> 201 l~-nps to 400 amps $40,00 __ <br /> 401 ammpss to 600 amps $80,00 __ 2 <br /> <br />D. Branch Circuits <br /> New, Alteration, or Exteaslon Per Panel <br /> <br /> a) The fee for branch dreuits w~th <br /> <br /> Each branch 0reuit $2,00 <br /> b) The fee for branch drcut~ without <br /> <br /> Fir*t braoeh ~feuit $~8,00 <br /> Each additinna/branch drcalt ___ $2.00 <br /> <br /> Miscellaneous (Service or Feeder Not Include~l) <br /> Each pump or irdgatinn eircIe $40.00 __ <br /> Each sign or outline ~.~htt~g ---- $40.00 -- 2 <br /> ~ignal ~ircult(s) or a/imlt~d ~nmrgy <br /> panel, ~lmvatlon or cxt~sion $40.00 -- 2 <br /> <br /> over di~ a~J owabl~ in ~y of <br /> ahoy, pur Inspection $35,00 <br /> <br /> Minor Installation Labels <br /> Pack of 10 labels @ $5.00 each____ $50.00 <br /> <br /> ( A~ required by ~uildin$ Official) <br /> <br /> 60.00 <br /> Al, Enter total of fees from Sec. #4 $ <br /> 00 <br /> A2. Add 5% surc. haege (.05 x Al) <br /> $ <br /> <br /> Subtotal $ 63 · 00 <br /> <br /> B, Enter 25% of line Al for Plan Revlew <br /> (Sec. 3), if requ/red $ <br /> C. Inve~tigation Fee (if requlred) <br /> D. Reinapucfion Fee ($25.00) <br /> TOTAL AMOUNT DH15 $. 6 3 · 00 <br /> <br />Receipt No. , ........ <br /> <br /> <br />