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FOR OFFICE USE ONLY <br />Received by:_ <br />Date: <br /> <br />MARION COUNTY BUILDING IN$?ECTIO~ <br /> <br /> ~ Salem, Oregon 97301 UU . . <br /> <br />Phone SSS-S 147 8;00 am - 4:30pm <br />Code. A.Phone: 588.7904 <br />PAx: 5ss-794s SITE #: <br /> <br /> Date: <br /> <br /> Issued by: <br /> <br />ELECTRICAL PERMIT APPLICATION ' <br />Please complete al~ Sections, 1 through 5 <br /> <br />I. LOCKfION OF INStALLATiON <br /> <br />JobAddmss 20727 Highway 99E <br /> Aurora I Cro~s $~ <br /> <br />PF~VIITS ARE NON-TRANSFERABLE AND NON-REFUNDABLE AND <br />EXPIRE IF WORK IS NOT STARTED W1TRIN 1S0 DAYS OF ISSUANCE <br />OR IF WORK iS SUSPENDSD FOR 1 S0 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />Elect ~cal Cc~t~cto~ <br /> E~ ' Pb~981-3913 <br />Ma/llngAddm~s]~O BOX 266, Hubbard OR 97032 <br /> <br />Ptc~ayOwn~t Oregon Flowers, Inc, I Pimne678-2580 <br />ContractoC5 IJeanse ~o, 24-205C <br /> <br />Comraetofs Board Keg. No. 50829 I Jo~ No, <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br />Pmpsgy Owner <br /> <br />M~ling Addm~a <br /> <br />City/State/Zip <br /> <br />Owner's Signature <br /> <br />3, PLAN REVIEW SECTION <br /> <br />We will provide plan review service if you complete Section <br />5B add submit two (2) sets of plans and specifications with <br />this application. <br /> <br /> This optional plan review progrmn does not suspend the <br /> rcquffed submission of lighting power calculations, plans, <br /> and specifications when required by the Oregon Structural <br /> Specialty Code, Chapmr 53. <br /> <br />MC 15-34 71/91 <br /> <br />4. FEE SCHEDULE (Complete a~d enter total in A 1 b~low) <br /> Number of Inspections per permit allowed -~ <br />A. <br /> R~idential <br /> Per <br /> Unit <br /> / <br /> Service Included: Items Cost (ca~h) SumI <br /> <br /> 1000s~ls, ft, or le~s $85,00 , , 4 <br /> Each additional 500 sq. ft, <br /> or portion thereof $15.00 <br /> Limited ~nerg¥ $20.00 1 <br /> Each Manu£d Home or Modular <br /> Dwelling Sc~vlc~ or Feeder $40.00 __ 2 <br /> <br />E, Se~¥1ee$ or Fteders (Doe~ not inlcnde b~4nch C~rculL% see xection D) <br /> <br /> IIlstallatlon, Alterations ur Reloeatio~ <br /> ~00 amps or less -- $50,00 ~),~)r * O0 2 <br /> ~1 am~ to 4~ ~nps $60.00 -- 2 <br /> ~1 am~ to ~ amps $100,00 ~ 2 <br /> ~1 am~ m 1~ amps $130,~ ~ 2 <br /> ~r 1~ ~ps or vol~ $300.00 2 <br /> ge~ect ~ly $40.00 __ 2 <br /> <br /> 2~ amp~ or less $35.00 __ 2 <br /> ~01 ~ps to~0am~ $40.00 ~ 2 <br /> 401 ~ps to ~0 a~ps SS0.00 ~ 2 <br /> ~6r ~ mps or 10~ volta <br /> <br />Bra~ch CIrcul~ <br />a) ~e f~ for ~anO ~mMts ~th <br />E~h brach drcuk lO $z~ 20. O0 <br /> <br /> b)~¢ f~ for br~ ~muts wi~out <br /> ~mha~c of sc~ice ~r f~e~r <br /> Fi~t branch elf cult $35,00 <br /> ~ach ~di~onM bm~ cimult $2.00 <br /> <br /> M[a~llan~us (Service or Feeder Not Incinde~) <br /> ~ch prop ~ iffiga6~ ciml¢ $40.00 ~ Z <br /> ~ch si~ or ~ne li~h~g , $40,00 ~ 2 <br /> S~nal ~cint(a) or a ~d ~e~y <br /> ~nel, alteration or ~tmsion $40,00 ~ 2 <br /> <br /> a~ve. p~ ~n ~ $35.00 <br /> ( A~ mquired &y BuiMing OfficiaO <br /> <br />5. FEES <br /> Al. Enter total of fees from See, #4 $ ~ <br /> A2, Add 5% surcharge 605 xAl) <br /> <br /> Subtotal $ 73.50 <br /> <br /> B. Enter 2,5% of line A 1 for Plan Review <br /> (Sec. ~), if reqinred $ <br /> C. Investigation Fcc (if requital) $ <br /> D. R~inapectlon gee ($25,00) $ <br /> TOTAL AMOUNC£ DUE $ 73.50 <br /> <br /> <br />