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FOR CITY USE ONLY ~.~ ./,~, ~ ~{~ ~ [-~ MARION CO~ B~D~G ~SPE~ON R~eiv~ By: Da~: ~l V ~ 3150Sflem,~Cm~r~gon ~' ~-97305Suite C ~ning By: City: 8:~m - 4:3~m 24 ~ Ins~on Line 373~27 F~ 588Q~8 ~E SC~DULE (c~ple~ ~ ~r t~ in Al) mARION OOUN' Please complete all Sections, I through 5 LOCATION OF INSTALLATION Parcel ID: ~ City: ~ Zip~ Cross StreeuDitectloas: ~:, PERMITS ARE NON- TRANSFERABLE AND EXPIRE IF WORK IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE OR IF WORK IS SUSPENDED FOR 1~0 DAY& 2A. CONTRACTOR INFORMATION ,el!tamPA Electrical const. Inc. City: - ~e ~{al~5 ~(~ Phone: no.: Signature of Supervising Elec~ieinn: 2B. FOR OWKgR INSTALLATION Property Owner. (please p~nt) Mailing Address: City: S~: Zip: I am the PROPERTY OWNER and own, reside in, or will reside in the completed structure and will be my own general contractor. I understand that I must register as a construction contractor ~f the structure is sold or offered for sale before or upon completion. If I hire subcontractors, I will hire only subcontractors registered with the Co~truction ContraCt°rs BoanL If I change my mind and do hire a general contractor who is registered with the Construction Contractors Board, I will immediately not~fy Marion County of the name of the contractor ~ O',v~'s Signature: . . 3. PLAn REVIEW sECTIoN ,.. Madon:~ounty does not require a plan review. We will provide phm review service if you complete Section 5B and submit twq (2) sets of plans and spenifieafions with this application. nor N~ of hspecdons pet permit allowed A. Residential Per Unit Service Ineinded: 1000 sq. ft. ~x less F-ach additional 500 sq. ft. or portion thereof -- Limimd Energy Each Mmu factu~d Hon~ or Modular Dwelling Service ~r Fe~der Items Cost (each) Sara __ x $110.00=$ 4 x $20.00 = $__ -- x $30.00=$__1 -- x $52.00=$ 2 B. S~rvic~ or Feeders (Does ~ot indude branch Circuits, s~e section D) 200 amps or less -- x $65.00 = $ -- 201amps to 400 amps -- x $80.00=$ 401amps to 600 amps -- x $130.00=$ 601 am~ to lO00 aml~ -- x, $170.00 = $ Ovg 1000 amps or volts -- x $390.00 = $ gecenne~ Only -- x $55.00 = $__ 200 amps or lc~s __ x $45.00=$__ 201amps to 400 amps -- x $55.00--$__ 401 arapsto600arnps -- x $110.00=$__ Ovg ~00 amgz or 1000 volts ~ "B" above D. Btnm~ Ctrcnits E. Mis~:elinn~om (Setwice or Fe~der Not lndudod) ~ach pump or irrigation ¢ircle -- x $55.00=$__ F. ach Sign or ~ Lighting -- x $55.00 = $ -- above, per Insln~ton -- x $50.00 = $__ G. Minor Ins~llaflon Labol~ (Sold only lo Electrical Comractors) It. Industrial Plant -- x $62.50d'~ = $ -- On~ffwoPamayDwellingre~:Sq. Feet -- x $ .09=$__ Dw~ing permit Labels (For Single Family Dwellings Only) OTHER, as ~lnimt by the Building Official $ -- x $50.00 = __ x $3.00=$__ N/C Al. Enter total of fees from Sec. qM. A2. Add State Surcharge (~% x Al) , 0-/ $. SUBTOTAL $ B. Enter 30% of line A 1 for Plan Review $.__ C. Investigation Fee (if required) $ D. Reinspection Fee ($50.00) 3) $.__ E. Additional Plan Revie~ ($62250/hr, - minimum one-half hour) $. F. Inspection for which no fee is specifically indicated, ($62.SOthr, minimum one hour) $ . ,,.:,... G. Inspection Outside Normal Business Hours, ($62.50/hr, minimum two hours) $ __ H. Industrial Plant ($62.50/hr) $ TOTAL AMOUNT DUE 2 2 2 2 2 .2 MC 15-34 Rev 9/98