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FOR el 1 ICE USE ONLY <br />Received by; <br />Date; <br /> <br />ELECTRICAL PERMIT APPLICATION <br />P/ease complete all Sections, 1 through 5 <br /> <br /> I. LOCATION OF INSTALLATION <br /> <br />MARION COUNTY BUII,I)ING INSPECTION <br /> <br /> 220 High Street NE <br /> Salem Oregon 97301 <br /> <br /> Phone 588-5 [47 8:00 am - 4;30pm <br /> Code-A-Plion¢: 588-7904 <br /> PAX: 588-7948 SITE #; <br /> <br /> Date: <br /> <br /> Issued by: <br /> <br />Permil No. <br /> <br />~ob^da,.s, 14452 ARNDT ROAD <br /> AURORA Icr°~ st' AIRPORT <br />,i,:c,i~{~ COLUMBIA HELICOPTERS <br /> <br />ROAD, <br /> <br />De,cd,don CLEAN ROOM WIRING <br /> <br />l'i~tLMl'l'S ARS NON.'IILd. NS FERA BLE AND NON-REFUNDABLE AND <br />I~XPIRE IF WORK I$ NOT STARTED wrflllN 180 DAYS OF ISSUANCE <br />OR IF WORK IS SUSP ,~qDED FOR 180 DAYS, <br /> <br />2A. CONTRACTOR IN$1'ALLATION ONLY <br /> <br />B~md¢.t c<~,,t~o~orF R A H L E R E L E C. <br /> <br />....... [Pho.~639-'~627 <br /> <br />211, FOR OWNER INSTALLATIONS,,. <br /> <br />The [.~stallation is bclng mad~ on propeay I own wkigh is n~ inumded for sate. <br />lea ¢, o,,,.t. REllJRN ORIGINAl. <br /> APPLICATION <br /> <br />3, PLAN REVIEW SECTION <br /> <br />We, will provide plan review service if you complete Section <br />5B aild submit two (2) sets of plans and specifications with <br />dlis application. <br /> <br /> This optional plan review program does not suspend the <br /> require<l submission of lighting power calculations, plans, <br /> · arid speei.ficafions when required by the Oregon Structural <br /> Specialty.Code, Chapter <br /> <br />MC 15~34 11191 <br /> <br />4. FI~E SCHEDULE (Complete ~d enter total in ,'X I helow) <br /> <br />A. Residential Per Unit <br />Service Included: ' hems Coal (~ach) <br /> <br />1000 sq. fl- or lees $85.00 <br />Each a~fi~al 5~ sq. h. <br />ot~M~ thereof $15 00 <br />Limited Enemy $20 00 <br />Bach M~nuCd Home or M~ula~ <br />Dwelfing Se~ of Peedec $40.00 <br /> <br /> Ins~llaU0n,2~ am~ or lessAIterati°ns 0r Rcl~athm ~ 60.00 <br /> , * 0,00 <br /> 201 m~ to 4~) amps <br /> ~1 amps io ~ amps $I00.~ <br /> ~1 am~ to 1~ amps ~ $130~ <br /> ~r 1~ ~ ~s or volta $300 ~ <br /> <br /> 201 amps $o 430 amps <br /> 401 amps to ~K) amps , <br /> <br />D, Branch CIrcul~ <br /> <br /> oucchase of ~er~ie~m' fe~er fee <br /> I~ach brach circui[ 5 <br /> <br /> Bach ~mp or i~gafi~ circle <br /> Each riga qt ~tlln¢ lighting ...... <br /> <br />g ~ach additional lnsp~Bon <br /> a~ve, pet b~s~ofion <br /> <br />G. Minor inalallallon Labels <br /> Pack of 10 la~ls ~ $5.~ each <br /> <br /> 11. Olher <br /> ( As required by B~ildin~ <br /> <br />$35,00 __ 2 <br />$40.00 __ 2 <br />$8000 - 2 <br /> <br />sa0o 10.00 <br /> <br />$3500 <br /> <br />$4000 ____ 2 <br />$40 O0 __ 2 <br /> <br />$40 O0 ____2 <br /> <br />$3500 <br /> <br />$5000 <br /> <br /> 5, FEES <br /> Al. Enter local of fee* from Sec, ~4 <br /> A2, Add 3% $urchargc (.05 x A I ) <br /> <br /> Subtotal <br /> <br /> (Se~. 3 . if mquited <br /> C. Inv~tigation Fee~, (if required) <br /> D, Reinspe~fi~ Fcc ($25,00) <br /> <br />..... Receip~ No, <br /> <br />$ <br />$ 63.00 <br /> <br /> <br />