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FOR. OFFICE USE ONLY <br /> Rece,ved by: <br />· Date: ,. <br /> <br /> Please complete all Sections, I through 5 <br /> <br /> 220 High <br />salem, Oreg~W301 <br /> <br />1, LOCATION OF INSTALLA~ON '~t~ <br />~'obAda,~aa 11685 Lark Court NE <br /> <br />aw Aurora { c~a st. . ... <br /> <br />~r~cdms Century Meadows mobile park <br /> <br />New mobile home <br /> <br />PEKMi'I'$ ARE NON-TRANS~RABLE AND NON-REFUNDABLE AND <br />BXPf~E IF WORK IS NOT STARTED WITHI'N 1 S0 DAYS OF ISSUANCE <br />OR IF WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A, CONTRACTOR INb'FALLATION ONLY <br /> <br />~l~.aaaams P0 Box 266, Hubbard 0R 97032 <br /> <br />Contractors Ncms~No, 24-205C <br /> <br />Con.actors Boara Reg. No. 50829 <br />Signature of SuI~nzhlng El~tfi¢ian g <br />s~wkot~,,, Lk=~e No.,,, 3138S <br /> <br />IIob No, <br /> <br /> Phone No. 981-3913 <br /> <br />2B, FOR OWNER INSTALLATIONS <br /> <br />City~Starship <br /> <br />Th~ installation is b~ing mad~ on pro.ny I own which i* not ~nded ~or sal~, <br /> <br />Owners SisDatum ...... <br /> <br />3. PLAN REVIEW SF~TION <br /> <br />We will provide plan review service if you complete Section <br />5B and submit two (2) sets of plans and specifications with <br />this application. <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 S~'nctural <br />Specialty Code, Chapter 53. <br /> <br />4, FEE SCHEDULE (Compete and enter total in A I bc~w) <br /> <br />A, Residential Per Unit <br /> Service Included: <br /> <br />$85,00 __ 4 <br />$15,00 <br /> <br />1000 sq, R, or less <br />Each additional 500 sq, ft. <br />~t po~on thereof <br />Limlt~d Energy ~ $20,00 __ 1 <br />E ach.~anu f.~I~ml~..r Mod u 1 a r <br /> $40 00 <br /> <br />B. ~ Feeders (Do~s not inlcude branch ~{rcuitz, see s~liOll D) <br /> <br /> 200 amp~ o~' Ics~ <br /> 201 amps to 400 amps <br /> 40}'amps to 600 amps <br /> <br /> Re~m~eet only <br />C. Te~rary Servlc~ders <br /> <br /> 2~ ~ps or~ <br /> ~1 ~ps to ~0 amps <br /> ~1 ~,pss to ~0 amps <br /> ~%6~ raps or 10~ volts <br /> s~ B a~e <br /> <br />D, Branch Cl~ul~ <br /> New~ ARcvatlon, or E~ension Pry ~ncl <br /> <br /> a) ~e f~ for br~ <br /> pu~hasc ~ s~ ~e~er fee <br /> <br /> b) ~e f~ f~ <br /> <br /> Each addi~on~ btan~ ~ult <br /> <br />E~ M~ellan~us (Servi~ or Feefle~ Not Included) <br /> <br /> ~ si~ or ~ffin~ <br /> ~gn~ e~t0) or a ~ted <br /> <br /> ~cr ~c allowable <br /> <br />G. Minor In~llatlon <br /> Pack ot 10 la~s <br /> (aold only to eJeatrlcal contractors) <br /> <br />H. ~her <br /> ( As ~q~rad ~ BulldOg O~c~0 <br /> <br /> ~50.00 <br /> 60,00 <br />$100.00 <br />$130.00 <br />$300,00 <br />$40,00 <br /> <br />$35.00 <br />$40,00 <br />$80,00 <br /> <br />$35.00 <br /> $2.00 <br /> <br />$40,00 <br />$40,00 <br /> <br />$40,00 <br /> <br />$35,00 <br /> <br />$. FEES <br /> Al. Enter taal of fees lmm Sec. #4 <br /> 4% Add 5% sur~arge 605 x A 1) <br /> <br /> Submml <br /> <br /> B, En~r ~% of ~nc A1 for Plan ~view <br /> ~, 3),if ~q~ <br /> C. ~vesfigafionF~ ~mqu~d) <br /> <br /> ~TAL AMO~ DUE <br /> <br />$ <br />$ PAID <br /> <br />MC 15-34 11/91 R!99i~No- <br /> <br /> <br />