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ELEC - 1616147
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ELEC - 1616147
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Last modified
2/9/2013 6:47:48 PM
Creation date
4/3/2005 1:15:41 PM
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Permits
Permit Address
20167 GRIM RD NE
Permit City
Aurora
Permit Number
555-99-06323
Parcel Number
041W22B 01800
Permit Type
ELEC
Permit Doc Type
Permit Document
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FOR CITY USE ONLY <br />R~eive~ By: Date: <br />~ 'Zoning By: City: , <br />~, Receipt #: Amount: $ ~ <br /> <br /> ELECTRICAL PERMIT APPLICATION <br /> Please complete all Sections, l through $ <br /> <br />L LOCATION OF INSTALLATION (~ <br /> Parcel ~: ~ <br /> <br /> City: ~q ~ Zip: <br /> Cross Str~i~c~ons: <br /> <br /> PERMITS ARE NON. TRANSFERABLE AND EXPIRE IF WORE <br /> I <br />IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br />· ~ WORX IS SUSPENDED FOR 180 DAYS. <br /> <br /> 2A. CONTRACTOR INFORMATION <br /> <br /> S,a,e:6 zip,, <br /> <br /> ~B. FOR OW~R ~ST~LATION <br /> <br /> ~o~ay Owns: ~lease prinO <br /> <br />Mailing Address: <br />City: State: Zip: <br /> <br />I am the PROPERTY OWNER and own, reside in, or will reside in <br />the completed structure and will be my own genen~l contractor 1 <br /> <br />structure is sold or offered for sale before or upon completion, lf l <br />hire subcontractors, I will hire only subcontractors registered with <br />the Construction Contractors Board. If I change my mind and do <br />hire a general contractor who is registered with the Construction <br />Contractors Board, I will immediately notify Marion County of the <br /> <br />3. PLAN REVIEW SECTION <br />IMarion County does not require a plan review. We will provide plan <br />review service if you complete Section 5B and submit two (2) sets of <br />plans and specifications with tMs app cation. <br /> <br /> MARION COUNTY BUILDING INSPECTION <br /> 3150 Lancaster Dr. NE - Suite C <br /> Salem, Oregon 97305 <br />8:00am - 4:30pm 24 HR Inspection Line 373-4427 FAX 588-7948 <br /> <br />4. FEE SCHEDULE (complete and enter total in Al) <br /> <br /> Number of Inspections per permit allowed <br /> A. ReMdential Per Unit Service Included: <br /> <br /> Items Cost (each) Sum <br /> x $110.00=$__4 <br /> x $20.00=$__ <br /> x $30.00=$__I <br /> <br />-- x $52.00 =$__2 <br /> <br />B, Services or Feeders (Does not include branch Circuits, see section D) <br /> Installation, Alteration or Relocation <br /> 200 amps or less -- x $65.00 = $__ <br /> 201~nps ln 400 amps -- x $80.00=$__ <br /> <br />2 <br />2 <br /> <br />5. FEES Al. Enter total of fees from Sec. g4 <br /> A2. Add State Surcharge (.05% x Al) <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/hr, <br /> minimum one-half hour) <br />E Inspection for which no fee is specifically indicated. <br /> ($62.50/hr, minimum one hoar) <br />O. Inspection Outside Normal Business Hours. <br /> ($62.50/hr, minimum two hours) <br />H. Industrial Plant ($62.50/hr) <br /> <br />TOTAL AMOUNT DUE <br /> <br />MC 15-34 Rev 9~98 <br /> <br /> <br />
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