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FOR CITY USE ONLY <br /> Re~elved By: Dat~: <br /> Zo.i~ By: C~: <br /> <br /> ELECTffiCAL PE~ff A~PLICA~ON <br /> Pl~e ~l~e a~ S~o~, I th~gk 5 , <br /> <br />L LOCATION O~ ~AL~TION <br /> <br />PERM1YSAIt~NOI~Ib~ISFE~4BL~ANDE~t~IIt~IFWOIt~ [ <br />IS NOT $'I'AItlF. D WITI~N 1~0 DA I~ OF I&qUANC~ OR IF <br />WORI~ IS SUSPENDED FOR lbo DA Y~. <br /> <br />2A. CONTRACTOR IFIFORMATION <br />Co~ctor: JUDSON"S Inc. <br />Mnilinsnd~ 1390 13th St. SE. <br /> <br />Ci~/: Salem sm~: OR Zip: 97309 <br /> <br /> Phone: 363-4141 <br /> Fax: 399-8760 <br /> C~ ~No: 34604 <br /> <br /> I am the PROPER~ O~ER a~ ~n, reside in, or will re$~e In the <br /> <br /> s~ucture ~ soM or offered for Mit before or u~n comple~on. Ill <br /> birr su6c~torz, I wilt ht~ on~ subcon~t~s reg~tered with the <br /> Cons~ction Con~ac~rs B~rd. Ifl change ~ mt~ and do hlrt a <br /> gene~l con~actor who ~ reg~er~ with ~e Co~ction <br /> Con,actors B~rd, I wilt immediatt~ not~ Marion Counw of the <br /> <br /> stouON cool, try SUH.OlNG n~SPF. CTION <br /> 3150 Lan3150 Lancas~' Dr. NE - Suite C <br /> ~ Oregon 97305 <br />8~0 ~ - 4~0 pm 24 ~. ~ L~e 373~427 F~ 588-7948 <br /> <br /> ~ Restden~l Per Uni~ke Included <br /> I~ ~ (~ch) Sum <br /> <br /> ~ ~15~ ~. FL ~ ~ ~f ~ x $ 20.~ - $" <br /> <br /> ~ M~u~ H~ <br /> M~uI~ ~tl~g S~ m F~ x $ 52.00 - $, <br /> <br /> · ~es or Feeden ~oes ~t inchde ~nch Cin~ ~e ~cflou D) <br /> <br /> 201 ~4~ x $80.~ <br /> 401 ~ x <br /> <br /> ~ 1~ ..... x $3~.~ ~ $ <br /> <br /> C Tem~ ~k~eeden <br /> la~ Mten~a~ er Reloea~oe <br /> <br /> 201 ~4~ x $ 55.~ - $ <br /> 401 a~m~ <br /> <br /> D. Branch Cl~l~ <br /> New, ~te~flo~ or Extenshn Per Panel <br /> <br /> of~F~F~BrCk x $ 3.~- $ <br /> b)~e ~ ~e~i~t ~ <br /> <br /> 2 <br /> ~ ~Jt~l B~h C~il x $ 3.00 <br /> ~ Mi~el~o~t (~ke or Feeder Not Iuti~d) <br /> ~ch~fi~e x $55.~ = S <br /> ~hSi~fl~Li~ x $55.~ = $ <br /> <br /> F. ~ae~ Addifioeal lal~fie~, ever the allo~ble <br /> In any of the a~e, ~r Iss~cfion X S 30.~ ' S <br /> G. Minor Ins~lh~n <br /> <br /> (Sold ~y m ~ C~) <br /> ~ IndustrlaIHant x $62.50/ <br /> Ou~ Fami~ O~u~ Fee: ~, F~t x S ,09 = S <br /> <br /> D~Hing Permit ~h (Foc Sizzle Ftmlly ~llia~! Only) <br /> O~ER, ~ required by the Building O~cinl S <br /> <br />TOTAL <br /> <br />. 5. FEES <br /> Al. Enter Total Fees ~m Section #4 <br /> A2 Add State Sumharg~ 605% x Al) <br /> '7% SUBTOTAL: <br /> <br /> B. Enter 30% of llne Al for Plan Review <br /> £. Investigation Fee, if requital <br /> D. Relnspectlon Fee ($50.00) <br /> E. Additional Plan Review (62.50/hr, <br /> minimum one-half hou0 <br /> F. Inspection for which no fee is spech"tcally indicated, <br /> ($62.50/hr, minimum one hour) <br /> G.Inspection Out,|de Normal Business Horns, <br /> $62.50/hr, minimum two hours) <br /> H.Indumdal Plant ($62.50/hou0 <br /> TOTAL AMOUNT DUE <br /> <br />4 <br /> <br />I <br /> <br />2 <br /> <br />2 <br /> <br />NIC <br /> <br />$ ,~).O° <br /> s <br /> $ <br /> <br /> $ <br /> $ <br /> $ <br /> $ <br /> <br />s ,.5',q. <br /> <br /> <br />