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FOR CITY USE ONLY <br />Zoning. By:__ CilyL <br /> <br />ELECTRICAL PElrOtllT APPLICATION <br />Plea,se complete all Section$, I t&rougls $ <br /> <br /> MARION COUNTY IIUILI)ING INSPECTION <br /> 3 1.50 Lan:] 1:50 Lanca~-'ter Dr. NE - Suib: C <br /> RE~ S.em, O~gon 9730~ <br /> - 4:30 pm 24 hr, lns~cfion Line 3734427 FAX 588-7948 <br />MARION Cl IU~demfi,I Per UelL ~lce laduded <br /> <br />RIIILB~.a <br /> <br />P£RMITS~4RENON. T~/INSFISR~BLE,4NDEXPiREIFI~,ORI{ ] <br /> NOT ST/IRTED IF[TIffIN 180 D~ Y$ OF I~U~CE OR IF <br />~K IS SUSPENDED FOR 150 DA Y~ <br /> <br />IN <br /> <br /> CONTRACTOR INFORMATION <br />Co~lvaaor: KEIZER ELECTRIC INC. <br /> <br />1410 MADISON STREET NE <br /> <br />, City: SALEM aisle: OR Zip: 973 O 3 <br />Phone: 378 - 0267 <br /> <br />378-1861 <br /> <br />Con.actors Board No: 25359 <br /> <br />Contractor License No: 2 4 - 6 8 C <br /> <br /> Supervisor License No: 2 8 4 3~/~ <br /> <br />~IL FOR OWNER INSTALLATION <br /> <br /> Pro.fly Owner: (please print) <br /> <br />State: Zip: <br /> <br />PLAN REVIEW SECTION <br /> <br />Cost (~ch) Sum <br /> <br /> $ 20.00 = $__ <br /> <br />x $ 52.0O = $__2 <br /> <br />B. Services or Feeders (Does ~ol Include branch Clrc uiL% see S~ctloe <br /> <br />200 a~m I~ ~ x $65.~ <br />201 ~ to 400 ~ x 180.~ <br /> <br /> a) ~e ~ for bm~ c~i~ ~ ~e ourc~ <br /> <br /> ~eh AddJlJ~l B~ch C~it x ~ 3.00 <br /> <br />~ch Si~ or Oull~ Li~t~g x $ 55.00 <br />SJ~al C~ui~s) or a L~ Ener~ Panel, <br /> <br /> ~ck of I0 la~ls ~ $~0,00 ~ch x <br /> (Sol4 ~y to EI~I Con~o~) <br /> <br />TOTAL <br /> <br />5. FEES <br />Al, Enter Total Fees from Section t/4 <br />A2 Add Sram Surchm-ge (.05% x Al <br /> <br />SUBTOTAL: $ <br /> <br /> B. Enter 30% of linc Al £or Plan Review <br /> C. Investigation Fee, ffmqu~d <br /> D. Reinspecfion Fcc ($$0.00} <br /> E. Additional Plan Review (62.50/hr, <br /> minimum one-halfimur) <br /> F, Inspection for which no fee is specifically indicated, ' <br /> ($62.$0/hr, minimum one hour) <br />O. Inspection Outside Normal Business Hour% <br /> $62.$0/hr, minimum two hours) <br />H. Induslrfal Plant ($62.~O/hour) <br /> TOTAL AMOUNT DUE <br /> <br />$ <br />$ <br />$ <br /> <br />$ <br /> <br />$ <br /> <br />MC 15-34 Rev 9/98 <br /> <br /> <br />