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FOR CITY US~ONLY ] 3150 ~ 150 ~r Dr. NE - Su~ C %n~g By:. ' CJ~:. I~t,~J~y 2 6 [~-4:30pm 24~.~ionL~e37J~427 F~588-7948 ~lll/~lM~ IM~Di~HEDULE (complete and enter totsl ELECT~CAL PE~ff APPLICATION M~k~.~ P~r~ Pie~e co.lac aU Scions, I thmugh 5 [ ~ Num~ of I~i~ ~ ~it allow~ Itc~ C~ (~) Sum I.LOCATIONOF[NSTAL~T1ON [ 000S Ft.~ ~ . x $1 0.~$ ~arca D' ~ A~it~[ 500 Sq. Ft. or ~ion ~f x $ 20.00 ~ ~.- I ~- ~ .. 1_ ~ ~ ~ ~ices or Fcedcm ~oef not include br~nch Circui~ see ~cfion ~c' ~ 2~ ~orl~ x $65.~ ' [ 201 ~ to4~ ~ x $80.~ ~ ~ 6Olam~tol~0a~ x S170.00- , , ] R~ ~ly x $ 55.00 WO~I~SUSPEND~ ~R 150 DAY~ .2A. CONTRACTOR INFOR~TION Parkin Electric, Inc. 20250 S Molalla Ave. Oregon City, OR 97045 503-657-4958 fax: 557-1059 Contractors License #: 34-4C exp. 10~01-99 Supervisor: 4241-S exp. 10-01-01 Contractors Board Reg#: 35151 exp. 10-12-00 Metro # 2416 exp 11-01-99 l / . ,,V / I 2B, FOR OWNER INSTALLATION Property Ov~: (please print) Ci~: State: Zip: I am the ?ROPERTY OI~I£R and own, reside in, or will reside in the completed structure and w#l ge my ov/~ general conwa¢to~. ! under~mnd that I must register as a co~$1r~ction contractor if the structure i~ soM or offered for ~alt before or upon completion, h~re .~ubcontractor$, I wi# hire only subconffactor~ registered with the Construction Contractor~ Board, If l change my mthd and do hire a Contractors Board, t will ~mmediately notify Marion County of the aame of the co~tra¢Ior: 3. PLAN REVIEWSECTION Marion County does not r~quim a plan review. We will provide I plan review service if you complet~ Section 5B ami submit two (2) seas of~s a~d sp~ificatinm wilb. ~is appli~ati~. 201 amps m 400 amps 401 amps to 600 amps Owr 600 amps ce 1000 volts, s~"B" abovc D. Branch Circuits New, Alteration, or Extension Per Panel a) the fe~ for bra~cah cimuits w/th the ourchase 9f~ervicc or Feeder Fee. Ea Br Cfi x b) T~¢ foe for h~anch ~,ulta w~th~ut ~e vur~hase o f Servic~ or Feeder Fit~t Branch Circuit ] x Each Additional Branch Cin:uit x Miscellaneous (Service or Feeder Not Included) :h pump or irrigation ~irele x :h Sign or Outlin~ Lighting x ~al Circuit(s) or a Limited Energy Panel, ~'~. Each Additional Inspection, over the atiov~l~ G. Min~r Installation Labeb Pack of 10 labds ~ $10.00 each (Sold only to El~aical Contractors) D~elling Permit Labels (For Single Family DvnrlYmg~ Only) OTHER, as required by the Buildin~ Official $ TOTAL 5. FEES Al. Enter Total Fees from Section#4 A2 Add State Sumharg¢ (.05% x Al) $ 55,00 = $ 2 Sl 10.00 = $. 2 $ 3.00 = $ S 50,00 = $~) S 3.00 = $ $ 55.00 = $ , 2 S 55,00 = $ 2 $55.00~ $ 2 S 50,00 = $ x $100.00~ $ x $62.50/hr=$ x $ ,09 = S NIC B. Enter 30% of line Al for Plan Review C. Investigation FCC, if mqulrcd D. Reinspection FCC (S50.00) E. Additional Plan Review (62.50/hr, minimum one-half hour) F. Inspection for which no fcc is specifically indicated, ($62.50/hr, minimum one hour) G. Inspection Outside Normal Business Hours, $62.50/hr, minimum two i~ourS) H. indusl~al Plant ($62.50/hour) TOTAL AMOUNT DUE SUBTOTAL: MC 15-34 Rev 9/95