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FOR CITY VALIDATION <br />R~ceived by: <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br />COMMUNITY DEVELOPMENT CENTER <br />285 Church St NE · Room 132 <br /> Salem, OR 97301 <br /> <br /> 24 hr. inspection Line 373-4427 <br />Office: Phone 588-5147 8:00am - 4:30pm <br />FAX: 588-7948 <br /> <br />IELECTRICAL PERMIT ..APPLICATION <br /> Please ComPlete all Sections, I through <br /> <br /> 1. LOCATION OF INSTALLATION <br /> <br />lobAddress 144~2 ARNDT ROAD N.E. <br /> <br />civ AURORA <br /> <br />CIRCUIT FOR A/C ON ROOF <br /> <br />COLUMBIA HELICOPTER <br /> <br /> PEg. MITS ARE NON-TRANSFERABlE AND EXPIRE IF WORK IS NOT <br /> STARTED WlTI-HN 1~0 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDE~ FOR 180 DAYS. <br /> <br />2A. CONTRACTOR II~ISTALLATION ONLY <br /> <br />Iq¢c~rkalContracmr FRAHLER ELECTRIC COMPANY <br /> <br />Address 11860 SI4 GREENBURG ROAD, TIGARD, OR <br /> <br />Pbo.~ 639-4627 IFa~ 639-4673 <br />Propel~y Owner [ Pho~ 678-1222 <br /> <br />Contractors Lic~me No. 3 4- l ~ ~ <br />~uparvimr'sLimNo. 1816S I P~.a 639-4627 <br /> <br />2B. FOR OWNtlR INSTALLATIONS <br /> <br />Pwperty Owner (pleas~pri~g) <br />Mailing Adders I Phone <br /> <br />City/State~Z¥ <br /> <br />Owner's Signature: <br /> <br /> 3. PLAN R~VIBW SHCTION <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 15-34 1/96 <br /> <br />PERMIT NO: <br />Date: <br /> <br />Issued by: <br /> <br />4. FEE SCHEDULE (Complete and eater total in Al below) <br /> Number of lmpcctions per p~rmit allowed <br />A. R~idential pe~ Unit <br /> <br />Installation, Alterati~t or Relocation <br />200 amps or <br />201 amps to 400 amp~ <br />~01 amps to 600 amps <br /> <br />2~ am~ or <br /> <br /> ~eh branch circuit <br /> <br />$50.00 2 <br />$6O.0O 2 <br />$100.00 2 <br />$130.00 2 <br />$3O0.00 2 <br />$40.00 2 <br /> <br />$35.00 2 <br />$40.00 2 <br />$80.00 2 <br /> <br />$ ZOO <br /> <br /> b) The fee for branch circuits without <br /> <br /> Fimt branch circuit <br /> Each additional branch circuit <br /> <br />E. Miscellaneous (~e~viee or Fenice Nat Included) <br /> Each pump or irrigation ckele <br /> Each sign or outline lighting <br /> Signal eimuit{a) or a limited energy <br /> panel, alteralion or extension <br />F. Each additional Inspection <br /> Over the allowable in any of the <br /> above, p~r Inspection <br /> <br /> Pack of 10 labels @ $5.00 each <br /> (~old only to electrical coatr~ctors) <br />H. Oth~ <br /> (As cequic~d by Building Ol?-wial) <br /> <br /> Dwelling Permit Label <br /> <br />$35,00 35. O0 <br />$ 2.00 -- <br /> <br />$40.00 2 <br />$40.00 2 <br /> <br />$40.00 __2 <br /> <br />$35.00 -- <br />$50.00 <br /> <br /> $q. ft.x &068= <br /># of Labe~ N/C <br /> <br />5. FEES <br /> Al. Enter total o f fees fwm Sec. #4 <br /> A2. Add 5% surcharge (.05 x Al) <br /> Subtotal <br /> <br /> B. Eater 25% of line Al for Plan Review <br /> (Sec. 3), if required <br /> C. Investigation Fee (if required) <br /> D. Reinapection Fee ($25.00) <br /> <br /> TOTAL AMOWNT DUE <br /> Receipt No. <br /> <br />$. 35. O0 <br />$ 1.75 <br />$ 36_7~ <br /> <br />$.__ <br /> <br />$ 36 7~ <br /> <br /> <br />