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MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> 285 Church StNE· Room 132 <br />FOR CITY VALIDATION . e...PERMff NO: <br /> I ~mem, OR 97301 Ig~ ~ <br />Received by: <br /> <br /> Oflice: Phone 5$8-5147 8:00am~4:30pm ~.~ .... ~ ~ /~ <br /> <br />-- ~ -- FAX: 588-7948 "~ I$~ ~? ~Dy:~ ~//// <br />ELECTRICAL PERMIT APPLICATION . lya~ln' ~ ~..qu~ ~ <br />~Please complete all Sections, I through $ 4. FI~E SCI-II~D~f.~"/~,. ~,~.~b'/~.(~g lin Ai <br /> Nmnfi%r 6'l~l~j~o~s pe~ permit allowed <br /> A. R.id*nti. I Ve~ Unit /"/0-/~ <br />1. LOCATION OF ~NSTALLATION ,.~vieo ~.¢inded- Uer~ Cost(each) Sum / <br /> <br />Cl, <br /> <br /> PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT <br /> STARTED WqTHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />10G0 sq. ft. or less $85.00 4 <br />Each additional 500 sq. fl. <br /> or pot/ion thereof $15.00 <br />Limited Energy $20.00 1 <br />Each Manufactured Home or Modular <br /> Dwelling Service or Feeder $40.00 -- 2 <br /> <br />Parkin Electric, Inc, 20250 S Molalla Ave. <br />Oregon City, OR 97045 503-657-4958 <br /> <br />C. Temporary 8ervice~Feedars <br />Installation, Alteration, or Relocation <br />200 amps or less $35.00 __ 2 <br />201 amps to400 amps $40.00 __2 <br />401 amps to 600 amps $80,00 -- 2 <br />Over 600 amps or 1000 volts <br /> <br />D. Branch Circuit, <br /> <br />Contractors License #: 34-4C <br />Supervisor: 4241-S <br />Contractors Board Reg #: 35151 <br /> <br />Contractor's Board Reg No. e~ Job~No. <br />Signature of Supervising Electrician <br />Supervisor's License No. I Phone// <br /> <br />$ 2.00 <br /> <br />$35.00 '~Se''''' <br />$ 2.00 <br /> <br />2B. FOR OWNBR INSTALLATIONS <br /> <br />Property Owner (p/e~ ptir~) <br /> <br /> Mailing Address [ Phone <br /> Ci~/StatedZip <br /> Owner's Sign~tug: <br /> <br /> 3. PLAN RBVIBW SBCTION <br /> <br /> Marion County does not require a plan review. <br /> We will provide plan review service if you complete <br /> Section 5B and submit two (2) sets of plans and <br /> specifications with this application. <br /> <br />MC 15-$4 1/96 <br /> <br />Miscellaneous (~vlco or Foede~ Not Included) <br />Each pump or irrigation circle $40.00 __2 <br />Each sign or outline lighting $40.00 -- 2 <br />Signal circuit(s) or a limited energy <br />panel, alteration or extension $40.00 __ 2 <br /> <br />$35.00 -- <br />$50.00 <br /> <br />5, FEES Al. Enter total of fees from Sec. #4 <br /> A2, Add 5% surcharge (,05 x Al) <br /> <br />8obtotal <br /> <br />B. Enter 25% of line Al for Plan Review <br /> (Sec. 3), if required <br />C. Investigation Fee (if required) <br />D. Reinspection Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br /> Receipt No. <br /> <br />F. Each additional inapootion <br /> Over the allowable in any of the <br /> above, per Inspection <br />O. Minor Installation Labels <br /> Pack of l0 labels @ $5.00 each <br /> (sold only to electricM contractors) <br /> <br /> __sq.fl. x $.0~;8 =__ <br />#of Labels NfC <br /> <br /> <br />