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Ii)FOR OFFICE USE ONLY <br />Received by: <br />ate:_ - <br /> <br />[ ELECTRICAL PERMITAPPLICATION <br /> <br />MARION COUNTY BUILDING IN~I~ % ~ ~ ?) <br /> 220 Hi~h S~t ~ <br /> Sa~m, ~gon 97301 <br /> <br /> Phone 58g-5t47 g~ ~ - <br /> ~e-A-~: <br /> 59g-7~)4 <br /> SITE ~.. ~,~u ~.~B~ ' Per?t <br /> No. <br /> <br /> Issued by: <br /> <br /> 1. LOCATION OFIN~TALLATION <br /> JobAddmss 20~2..I.. Hwy. 99E NE <br /> City Aurora ] Cro~, St. <br /> mr~m~ Just south of Aurora by B. aptist Church <br />on PGE pole #2223 <br /> <br />( De~cdP';°nlOOA service on pole fq,r field drain <br />[ 0uraP ........ <br /> PF~RMITS ARE NON-TRANSFI]RABLE AND NON-P~I~JNDABLE AND <br /> EXPel] IF WORK I5 NOT STARTED WIDHN 180 DAYS OF ISSUANCE <br /> OR l~ WORK I$ SUSPENDED FOR 180 DAYS, <br /> <br />2A. CONTRACTOR IN~TALLATION ONLY <br />ElectricaIContractor JR Electric [Pa°ne981-3913 <br />MailJngAddmss PO BOx 266, Hubbard OR 97032 <br /> <br />Pmpe~yOwn~r Oregon Flowers I Ph°ne678-2580 <br />Conuaetofs Licems~ No. 24-205C <br />contra=ot's soanl Reg. No. 50829 ~ Job No. <br />Su~misofs ~nse No. 313.8S ] P~ ~o981_3913 <br /> <br />211, FOR OWNER INSTALLATIONS <br /> <br />Prol~gy Owner <br />Maillng Add.ss phone <br />City/StatelZip <br /> <br />Thc inst allatloa is be/~g made on pt,uppity I own which is not/mended l~r sale, <br /> <br />3. PLAN REVIEW SECTION <br /> <br /> We will provide plan review service if you complete Section <br /> 5B and sobmit two (2) sets of plans and specifications with <br /> this applicatiom <br /> <br /> This optional plan review program does not suspend the <br /> required submission of lighting power calculations, plans, <br /> and specifications when required by the Oregon Structural <br /> Specialty Code, Chapter 53. <br /> <br />MC 15-34 11191 <br /> <br />4, FEE SCHEDULE (Complete and enter total in A 1 below) <br /> <br /> Number of ] nspectlons p~r permit allowed <br /> <br />A. <br /> Residential <br /> Per <br /> Unit <br /> Se~lce Included: Items Co~t (each) S/lm/ <br /> <br /> $85.00 ~ <br /> 10~ ~q, A. or le~s <br /> Ea~ ad&~ 5~ sq. ~. <br /> or ~ ~e~of $15,00 <br /> Limi~d Enemy $~0,00 <br /> <br />Dwelling Servic~ or Feeder $40,00 <br /> <br />Installation, Alterations or Relocation, <br />R~mect only <br /> <br />a) The fee for branch circuits with <br /> <br />b) The fe~ for branch dtcuts withou~ <br /> <br /> Pack of 10 Iat~l~ @ $5.00 each <br /> <br />50.00 <br />$$60,oo 50, O0 2 <br />$100.~ 2 <br />$130,~ __ 2 <br />$300,00 __ 2 <br />$40,00 __2 <br /> <br />$35.00 <br />$40.00 <br />$30.00 <br /> <br />$2.00 <br /> <br />$35.00 <br /> $2,00 <br /> <br />$40.00 40~ O0 2 <br />$40.00 ., 2 <br /> <br />$40.00 <br /> <br />$35.00 <br /> <br />$50.00 <br /> <br />5. FEES <br /> A I..Enter total of fees from Sec, #4 <br /> A2, Add 5% at~rcharg¢ (,05 x Al) <br /> <br /> Subtotal <br /> <br /> B, Enter 25% of linc A I for Plan Review <br /> (See. 3), if ~qulred <br /> C. Inve~tlgationFee (if required) <br /> D. Reinspecfion Fete ($25.00) <br /> <br /> TOTAI~ AMOUNT DUE <br /> <br />$ qO. O0 <br />$ o, ;)u <br /> <br />$ <br /> <br />R~ceip~ No. <br /> <br /> <br />