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.FOR crr <br /> Received by: <br />I Date: <br /> <br /> Please complete a/I Sections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />~[r DEVEL??~ENT CENTER <br />~28l~j .C~h~rch St N~ Room 132 PERM~ NO: <br /> <br /> D~ <br /> Hr In~t~ L~e: <br /> 588-5147 81~ a.m. - 4130 p.m. <br /> F~: 58~ Issu~ by: <br /> <br />JobAdd~ess 11708 Donald Rd N.E. <br />ci~ Aurora [Cm~St. <br /> US West Site #219 / Southerland <br /> <br />l~cfipfi~ 1 Service, 1 Feeder, 2 circuits <br /> <br />PERIvffrs ARE NON-TRANSFERABLE AND EXPIRE IF WORK lS NOT <br />START[iD WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INffrALLATION ONLY <br />El¢ctr:,¢alContractor OREGON ELECTRIC { Ptto~¢ 23t~-9900 <br /> <br />MuiimgAddr~s 1010 SE llTH <br />Properly Owner Bectel ] Phone <br />Contractor's Liceme No. 26- 95 C <br /> <br />contr~J,-', ~o,rd l~g. No. 203 [ Job No. 71657-24 <br />Signature o f Supervising Electrician <br /> <br />liB. FOR OWNER INSTALLATIONS <br /> <br />Pwperiy Owner (plewse print) <br /> <br />Mailing Address I Phone <br />Ciiy/State/Zip <br />Owner's Signature: <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 />3K715-34 12/~4 <br /> <br />3. PLANRI/VII~W SBCTION~ <br /> <br />4. FBtl SCI-I]~DULB (Ccmplete and enter totalinAl below) <br /> Number oflmpo~tions per pemfit allowed -~ <br />A. <br /> Residential <br /> Unit <br />S~Inoloded: Items Co~t(each) Sum t <br />t000 ~q. ft. or l~ $85.00 4 <br />Each additional 500 sq. fl. <br /> or pmfion thereof $15.00 <br />Limited Energy :El0.00 1 <br />Each Manufaatur~d Hame or Modular <br /> Dwelling Servi,e or Feeder $40.00 2, <br /> <br />B. S~rvic~s or F~ed~r a (Do~s riot include br~mch ¢ire~its~ see s~tion D) <br /> <br />200 amps or l¢~s <br />201 amps to 400 amps <br /> <br />a) Th~ fe~ for branch ekcults <br /> <br /> Each sign or outline lighting <br /> Signal circuit(s) or a limited enel~y <br /> <br /> Pack of 10 labels @ $5.00 ~ach <br /> <br />$50.00 100.2 <br />$60.00 2 <br />$100.00 __2- <br />$130.00 2 <br />$3OO.OO 2 <br /> <br />$35,00 <br />$40.00 <br />$8O.OO <br /> <br />$ ZOO -- <br /> <br />$35.O0 <br />$2.00 <br /> <br />$40.00 2 <br /> <br />$35.00 -- <br />$50.00__ <br /> <br />__~q. ~. x i06 =__ <br /># of Labels_ NIC <br /> <br />5. FRES Al. Enter total of fe~s from Sec, #4 <br /> A2. Add5% surcbergn (.05 xAI) <br /> <br />Subtotal <br /> <br />B. ~ater 25% of line Al for Plan Review <br /> (Sec. 3), if required <br />C. Inv¢sligation Fee (if required) <br />D. Reuispection F~¢ ($25.00) <br /> <br /> TOTAL AMOUNT DUI5 <br /> Receipt No. <br /> <br />$ 104.00 <br />$ 5.20 <br />$ leO.90 <br /> <br />109.20 <br /> <br /> <br />