Laserfiche WebLink
u 0Fvic us . ON,.V <br />Received by: <br />Date: <br /> <br /> ED::CTRICAL PEF1MIT APPLICATION <br /> Please complete all Sections, I through 5 <br /> <br />I. LOCATIONOFINSTALLATiON <br /> <br /> 8864 Shaw Square Rd. <br /> Aumsville Ic~asu <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br />PERIvfi~S ARE NON - TR3u~S P"~ILABLE AND NON-REFUNDABLE A31D <br />EXPIRE IF WORK IS NOT STARTBD WrfltlN 180 DAYS OF ISSUANCE <br />OR IF WORK IS S USPF24D ED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br />E~denlCm~¢tor Code Electric Iph°nc 581-8684 <br />M~mgAa~ 2717 2..2....n~ $t~. SE - Salem <br />Pmpa~yOwpzr La~zlo Sandor , IPh°n~ <br />Comracto~, Lic~c No, 24-75C <br />Conwactor~a Board g~a. No. 1 9 8 6 6 I Jo~ N/x <br /> <br />Si~nu. umofaUl~rVUUlg Elec~rie~,m J ~ <br /> <br />S~rvi~or', I~n~ No. 2015 S <br /> <br />FOR OWNER INSTALLATIONS <br /> <br />Mailing Addg;s / Phone <br />Ci~y/'3t a~/Zip <br /> <br />Th~ inatallatlon is b~g mad~ on prol~rty I own which i~ not intended for ~ale, <br /> <br />Owner% Signature .......... <br /> <br />3, PLAN REVIEW SECTION <br /> <br /> We will provide plan review ,service if you compleu~ Section <br /> 5B and subreit two (2) sets of plans and specifications with <br /> ~/s application. <br /> <br /> . Thi~ optional plan review program doe.~ not suspend the <br /> required submission of lighting power calculations, phns, <br /> and specifications when required by the Oregon Structural <br /> Specialty Cede, Chaptea' 53. <br /> <br />MC 15-34 11/91 <br /> <br /> 220 High Street NE <br /> 'Salem, Oregon 97301 <br /> <br />Phon{ $88-~147 8:00 am - 4:30pm <br />Code.A-Phc. m,~: 5~8-7904 <br /> FAX: 588.7948 <br /> <br /> ............ <br />Date: gOT I ? !99_9. ' <br /> <br /> Issued b~,~,u,~ ........ <br /> <br />l 0~0 sq. fu or less $85,00 __ . <br /> $2o.oo <br /> <br /> 601 amp~)o 1000 aml~ $I~.~ <br /> <br /> ~ct rely $~.~ <br /> <br />C. Temporary Service.s/Feeders <br /> <br /> 200 ~mtp~ or less <br /> 201 ~pi lo 400 ~mp~ <br /> 401 mnps to ~ amps <br /> ~r~ ~ps or l~volt~ <br /> <br /> ,) ~: f~ for branch <br /> <br /> Ihch bnmch clmud <br /> <br /> ~rchase of ~ewlce or feeder fee <br /> <br /> linch addi~onal branch ciguit <br /> <br />~, Mlscellan~us (Service or Feeder No[ Included) <br /> <br /> ch sign or ~ne i~htmg <br /> Signal cimuit(s) or a h~4 enemy <br /> <br /> Pack ~ 10 la~ls <br /> <br /> ( A* reqdrtd by B~dding Offic~l) <br /> <br />$35.00 <br /> 40,00 __ . <br />BO,00 <br /> <br />$2.00 ...... <br /> <br />$35.00 <br /> $2.00 <br /> <br />$40.00 <br />$40.00 <br /> <br />$40.00 <br /> <br />$35.00 <br /> <br />$5O,00 <br /> <br /> S. FEES <br /> Al, Emcr ~cnal of f~¢s from Sec, #4 <br /> A2. Add 5% ~urchavd. c (,05 x Al) <br /> <br /> Subtotal <br /> <br /> B. Enter ~5% of llne A1 for PI~ Review <br /> (S~. 3), if mqmr~ $, <br /> C. ~ve~tlgatlonFee (~ ~ulmd) <br /> D. Rems~fi~ Fee ~) $ <br /> <br /> TOTAL AMOU~ DUE <br /> <br />.... ~ee!~ No, <br /> <br />,6o;o0 <br /> <br />$ 6~.oo <br /> <br /> <br />