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FO t~CITY. US~E ONLY <br /> R~c~iv~d By: Dst~: <br /> Zon~g By: CiW: <br /> <br />..................................... <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complele all Sections, I through $ <br /> <br /> Salem, O~gon 97305 <br />8:00 am - 4:30 pm 24 hr. Inspection Line 373-4427 FAX 588-7948 <br /> <br /> 4. FEE SCIIE <br /> <br />I. LOCATION OF INSTA. LLA.TION <br /> <br />Zip: <br /> <br />Phone: <br /> <br />Pro'.~:ct Dc~ription: ~. <br /> <br />IS NOT,TAR TED WI~tlIN 180 DA YS OF ISSUANCE OR IF <br />WORcK 15 SUSPENDED FOI{ 180 DAY~ <br /> <br />· 2A. CONTRACTOR INFORMATION <br />Parkin Electric, Inc. 20250 S MolaJla Ave. <br />Orego~ City, OR 97045 503-657-4958 fa~c 557.1059 <br />Contractors License#: 34-4C exp. 10-01-99 <br />Supervisor: 424~1-S exp. 10-01-01 <br />Contractom Board Peg #: $5~51 exp. 10-12-00 <br />Metro# 2416 exp 11-01-99 <br />Owner: <br /> <br />Contractor License No: <br /> <br />Supcn'vi$or License No: <br /> <br />Signature of Supervising Ele. c~i¢ian: <br /> <br /> P~q~c~y Ovmer; (ptease prinO <br /> Mailing <br /> Cily: Slate: Zip: <br /> <br /> I am the PROP£RTY OWNER and own. reside in, or will reside in the <br /> completed structure and will be my own general contractor. <br /> understand that t must register as a construction contractor if the <br /> structure is sold or offered for sale before or upon completion. Ill <br /> hire subcontractors, I will hire only subcontractors registered with the <br /> Construction ConlractorJ Board. Ifl change my mind and do hire a <br /> general contractor who is regtstered with the Construction <br /> Contractors Board. I will immediately notO~/ Marion County of the <br /> name of the contractor: <br /> <br />IOwna-'s Signam~: <br /> <br />3, PLAN REVIEWSECTION <br /> <br />Marion County does not r~qu/r~ a plan rcview. We will provide <br />plan review s~rvio~ if you compl~ Seciion 5B and submit iwo (2) <br />s~s of plans and s~cifications with this application. <br /> <br />MC 15-34 Rev 9/98 <br /> <br /> Number oflnspe~tiom per permit allow~d-- <br /> Service Included <br /> [tem-s Cost (each) Sum <br />0 St. FI. or I~ss x $ I 10.00 =$ , 4 <br />h Additio~1500 Sq. Ft. or ~ion ~f x $ 20.~ = $ <br />d~ x $30,00 =$ , 1 <br /> <br /> Semi. or F~e~ x $52.00 = g 2 <br /> <br /> ~. Services or Feeders ~I)oes not lnclnde brantg CSrcuila, see action D) <br /> <br />201 amps to 400 amps x $ 80.00 = $ 2 <br />401 amps to 600 amps x $130.00 = $ 2 <br />601 amps to 1000 amps x $170.00 = $ 2 <br />Over 1000 amps or volts -- x $390.00 = $ 2 <br />Reconnect Only x $ 55.00= $ 2 <br />C, Temporary SetwicexfFeeders <br /> <br />200 amps or less x $ 45.00 = $ 2 <br />201 amps to 400 amps x $ $5.00 = $ 2 <br />401 amps to 600 amps x $110.00= $ 2 <br />Over 600 amps or 1000 volts, sc~"B" above <br />D. Branch Circuits <br />New, Alteration, or Extension Per Panel <br />a) the fee for branch circuits with the ourchase .,~ <br /> ofServiceorFeederFee. EaBrCir ,.=.t x $ 3,00 = $l <br /> ) The fee for branch c/reuits without the <br /> <br /> tal Circuit(s) or a Limited Energy Panel, <br /> Pack of l0 [abels (~ $10.00 e~ch x $100.00= $ <br /> <br />Dwelling Permit Labels (For Single Family Dwellings Only) <br /> <br />OTIIER, as r~quired by the Building Official <br /> <br /> TOTAL <br /> <br />5. FEES <br />At. Enter Total Fees from Section #4 <br />,tO. Add State Surcharge (.05% x Al) <br /> <br /> 7q <br /> <br />SUBTOTAL: <br /> <br />B. Enter 30%of line A1 for Plan Review $ <br />C. Investigation Fee, if required <br />D. Reinspection Fee {$50.00) $ __ <br />E. Additional Plan Review (62.50?nr, <br />minimum one-half hour) $ __ <br />F. Inspection for which no fee is specifically indicated, <br />($62,50/hr, minimum one hour) $__ <br />G. Inspection Outside Normal Business Hours, <br />$62.50&r, minimum two hours) $ __ <br />H. Industrial Plant ($62.50/hour) <br /> TOTAL AMOUNT DUE $ 7Z70 <br /> <br />- qq, 55 <br /> <br />L <br /> <br /> <br />