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I oa omc I COUNTY sP cno <br /> <br /> " 'v '~ ' I 220Hi~hS~t~ ~ <br /> <br /> ELECTRICAL PERMIT APPLIGATION ~ ~ ~1 ~997 Date: __ <br /> Please complete afl Sections, 1 through 5 ~ ..... ,,~v ..... <br /> ,, , -- MARION uuum- ,~u~u uy. <br /> BUiLDiNG ~N~ ,F~T~ON. , <br /> <br />1. LOCATION OFINSTALL~'PION <br /> <br />JobA~a~s~ 9824 W. Stayton Rd. <br />city Aumsvitle { cro~ss,. Shaff Rd. <br /> <br />Directions <br />Dcscfipdon Security System <br /> <br />pERJMr['S A~E NON-TRANSFEP. ABLE AND NON-KEFUNDABLEANT) <br />EXPUtE D~ WORK IS NOT STM{TED WI'IlliN 1:80 DAYS OF ISSUANCE <br />OR ~ WORK iS SUSpI~NDED FOR 180 DAYS. <br /> <br />2A. CONTRACI'OR INSTALLATION ONLY <br />Electrical contra¢,orA1 ltec Security <br /> <br />I Pi,on=503/331-262 <br /> <br />M.R~gAdd~..po ~OX 55310 - Portland. OR 97238-53 <br /> <br />Property Owner David & Tanya Dalke IP~°"=503/749-394 <br /> <br />Contractors Licen** No. 26-307CLE ~ <br /> <br />28. FOR OWNER INSTALLATIONS <br />Property Owner <br />Mailing Address Phone <br />Cj ty/St ale/Zip <br /> <br />The installation is being made on property I own ',vhich is no~ intended for sale, <br />lease, or rent, <br /> <br />Owners Signature , . <br /> <br />3. PLAN REVIEW SECTION <br /> <br />We will provide plan review service if you complete Section <br />58 and submit two (2) sets of plans and specdications with <br />this application. <br /> <br />This optional plan review program does not suspend the <br />required submission of lighting power culculations, plans, <br />and specifications when requited by the Oregon Structural <br />Specialty Code, Chapter 53. <br /> <br />MC15-34 11/91 <br /> <br />Permit No~ <br /> <br />A. Residential Per Unit <br />Service [ncludedl <br /> <br />1000 sq. fl, ~*r tess <br /> <br /> Over 61~ ~un ~s or 10~ volts <br /> <br /> a) '13e fm for braach dre~s~ <br /> <br /> b) '~e f~ for branch drcms without <br /> <br /> ~hel, aheta~on ~r extrusion $40.00 <br /> <br /> $85.00 -- <br /> <br /> $15.00 <br />1 s2o.oo 20_.00 <br /> <br />5. FEES <br /> Al, Enter Iotalof fees from Sec. #4 $ 2000 <br /> A2. Add 5% surcharg~ (.05 x Al) $ --~ <br /> Subtotal $ gl. O0 <br /> <br /> B. EnIcr 25% of lima A1 for Plan Review <br /> (Sec, 3), if required $ <br /> C. lnvesHgation Fe.~ (if required) $ <br /> D. Relnspect[c~ Fee ($25.00) $ <br /> TOIAL AMOUNT DUE $ 21.00 <br /> Eecc[~ No. <br /> <br />4. FEE SCIIEDULE (Complete ~md enter total in A 1 below) <br /> <br /> <br />