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~c-A-~onc: 588:~' ~ SITE ~' Permit No. <br /> <br />ELECTRICAL PERMITAPPLICATION / t~ ~ Date: ~iL~,,,~ ~,~,3N <br />Please complete all Sections, 1 through 5 [ ,~ t~ I ~ ~- <br /> Issued b.. <br /> <br /> 1, LOCATION OF INSTALLATION 4, ~E ~C~E )UL~ (Complele ~d enter otal m A I ~low) <br /> <br />JobAddress 14996 Third St. <br /> <br />City A~rora ] Cm~ St. Liberty St. <br /> <br />Dimcdm. 2 blocks east of 99E on ~ird St <br /> <br />Dc~c~p~n ~IS~RIC ~S~TION <br /> <br />PIeR MITS ARE NON-~ANSFERABI.5 AND NON-RE~ABL~ AND <br />EXPIR}.~ IF WORK IS NOT STARTED WITH~ 180 DAYS OF ISSUANCE <br />OR iF WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A, CONTRACq'OR IN~ALLATION ONLY <br /> <br /> Owner ] Phone <br />Property <br /> <br />Ilob No, <br /> <br />IPhoneNo. <br /> <br />FOR OWNER INSTALLATIONS <br /> <br />p~0~ny Owner Brady Sheets <br />MaiImg^damss 13862 S. Carus Rd IIra°ne 632-4359 <br />City/Stam?gip Oreqon City,. OR 97045 <br /> <br /> PI.AN RI~JVlEW SECTION ,d <br /> <br />We will provide plmx review service it' you complete Sectior~ <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 Structural <br />Spec}alty Code, Chapter 53. <br /> <br />MC 15-34 11/91 <br /> <br /> Unit <br /> <br /> 1 <br />~ooo ~~. ~. or lcs~ <br /> <br /> c¢~ora~ther~o~ ,3 $m0o 45~® <br /> <br /> 2~ amp~ or less $50,00 ~ 2 <br /> 2~ amps or l~s~ $35,00 ~ 2 <br /> a) The fm for bta~lch <br /> Each additional branch circu{t $2.00 <br /> <br />5. FEES <br /> <br /> Al, Enter total of fees from Sec. #4 ~ 130.00 <br /> A2, Add 5% <br /> <br /> Subtotal $ <br /> <br /> B. Enter 25% of line A 1 for Plan Review <br /> (Sec. 3), if required $ <br /> C. lnve~tjgalionFee (if requlmd) $ <br /> 'D. Reinspecli~,n Fee ($25.00) $, <br /> TOTAL AMOUNT DUE $ 136,50 <br />,. 14-61 <br /> <br /> <br />