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FOR CITY USE ONLY <br />Raceived By'._ Datu: <br />Zoning By: ' ~' City: <br />Recei~ #: Amount: $ <br /> <br />I ELECTRICAL PERMIT APPLICATION <br /> Please complete all Sections, I through 5 <br /> <br /> LOCATION OF INSTALLATION <br /> <br /> 11.2=96 £hlzzq <br /> ft:t zip: <br /> <br />PERMIT~ APE NON. TK41~IrERABLE AND EXPIRE IF R/OP.K <br />IS NOT STAR TED WITHIN 180 DA Y$ OF ISSU.4~CE OR IF <br />WOI~ I$ $USpENDED FOR 180 DA ¥.~ <br /> <br />2A. CON"tRACTOR INFORMATION <br /> <br />Parkin Electric, Inc. 20250 S blolalla Ave. <br />Oregon City, OR 97045 503-657-4958 fax: 557-1059 <br />Contractors License #: 34-4C exp. 10-01-99 <br />Supervisor: 4241-S exp. 10-01-01 <br />Contractors Board Reg #: 35'151 exp. 10-12-00 <br />Metro # 2416 exp 11-01-99 <br />Owner: <br /> <br /> gnamre of Supervising EIo:O-ician: ~_~ <br /> 2e. FOR OWNER INSTALLATION <br /> <br /> Property Owner: (please prinO <br /> <br /> structure is sold or offered for sale before or upon completion, If l <br /> <br /> RECEIVED oNcowB , . IN,P=. <br /> 3150 Lan3150 Lancaster Dr, NE - Suite C <br /> Salem, Omgen 97305 <br />?IF 2 ~o~'~4:30pm 24hr. lnspeetionLin¢373-4427 F~588-7948 <br /> <br /> -- ..., ~DULE (complete and enter total <br /> <br /> Num~ of I~io~ ~ ~it allow~ <br /> <br /> l~m C~ (m~) Sum <br /> 10~ St. FL or I~ x S 110,00 <br /> ~ ~difio~1500 Sq. Ft. ~ ~ion ~f x $20.~ <br /> L~t~ E~e~ x $ 30.00 <br /> <br /> B. ~ices or Fc~e~ ~o~ not include branch Circui~ ~e ~cflon <br /> <br /> 201 ~400~ x $ 80.00 <br /> 401 ~W600 ~ x $130,~ <br /> 601 am~ 1000 am~ x $1T0,00 ~ <br /> ~ 1~ ~or vol~ x S390.~ <br /> <br /> 201 a~ to 400 sm~ x $ 55.~ <br /> 401 a~ to~0 a~ <br /> ~ 600 a~ or 10~ vol~ <br /> <br /> . a) ~e ~ for b~h c~i~ ~ ~e uumha~ <br /> ofS~i~ ~ F~der F~. ~ Br Ck x <br /> 3) T~ ~ for b~ch ¢mi~ ~out <br /> <br /> F~ Bunch C~u~ <br /> <br /> ~ pump or ~ti~ ¢~le ~ x $55,~ <br /> · Si~ or Outl~ Li~t~ x $55,~ <br /> ~1 C~ui~s) m a L~ E~ ~nct, <br /> <br /> ~Eaeh Addifioeal i~s~eflo~, ~er Ibc allonge <br /> la t~y of the a~ve, ~r i~cfio~ x $ 50,~ <br /> G, Minor Installation <br /> Pack of 10 la. Is ~ $ t0,~ tach x <br /> (Sold o~y to EI~I ~n~om) <br /> H. Industrial Plant x S62.50/~ <br /> One~ Family D~lling Fee: Sq. Fret x <br /> <br /> D~lting Permit ~ts (For Single <br /> O~ER, as required by the Building Official $ <br /> TOT~ <br /> <br />Owner!s Signature: <br /> <br />3. PLAN REVIEWSECTION <br /> <br /> Marion County does not require a plan review. We will provide <br /> plan I~vicw service if you complct~ Section 5B and submit two (2) <br /> sets of plans ~ad specifications with this ~¢pl~cation. <br /> <br />5, FEES <br />Al. Enter Total Fees from Section #4 <br />A2. Add State Surcharge (.05% x Al) <br /> <br />SUBTOTAL: <br /> <br />B. Enter 30% of llnc A1 for PI,an Review $ <br />C. Investigation Fee, if required $ ~ <br />D. Reinspectinn F~c ($50,00) $ __ <br />E. Additional Plan Review (62.50/hr, <br />minimum one-half hour) $ ~ <br />E Inspection for which no fee is specifically indicated, <br />($62.50/hr, minimum one hour) $ __ <br />G. Inspection OumideNormal Business Hour, <br />$62.50/hr, minimum two hours) $ ~ <br />H. Indusixial Plant ($62.50/hour) <br /> TOTAL AMOUNT DUE $ .(X~Z. ' ::Z> <br /> <br />MC 15-34 Rev 9/98 <br /> <br /> <br />