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FOR CITY vALIDATION] <br />ReeeiYed by:_ __ [ <br />Date: -- ] <br /> <br />24 Hr Inapc~tion Line: 588-7904 ~[0N COUNTY <br />Oflica: 588-5147FAX: 588-79488:00 a_,n.- 4:30 p.m. I$~_~}~ [~lqPlx0,q'[()U ..... <br /> <br />ELECTRICAL PERMIT APPLICATION I <br />PIoa$o oompleto all Sections, 1 through 5 <br /> <br />L LOCATION OF INSTALLATION <br /> <br />¢22 @ Golf' Club Road <br /> <br />tx.~,,10ti..,. T¢.o'lp.clEgry__._.Se. rvi. ce for <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF W O1.~2 IS NOT <br />STARTED WITHIN I~Xl DAYS OF ISSUANCE OR IF <br /> WORK tS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />~l¢.t,.~¢~c,,,...~,c.,,. Linnc0 E] ectr~c C[phou< 503) 926-42 <br />Mailing Add,if~.._._p__.0__~_O_?( 9~:, A1 bany 0~_~7,32I <br />r.,rmyOw.~,. St. of Oregon ~ ~one <br /> <br />Stq~rvisor'a Licmme No, 32575 Phone( 503 ) <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br />c. il__y_/~!at~z_ip__ ........ <br /> <br />3. PLANRBvIEW SECTION <br /> <br />Marion County does not require a plan review. <br />We will provide plan review service if you complete <br />Section 518 and submit two (2) sets of plans and <br />specifications with this application, <br /> <br />4. FEE fiCHEDIILI~. (Colnplel¢ axld entre' Iotld hi Al below) <br /> <br />A. R~id~ntial Per Unit Nmnber oflnspeellons per permit allowed <br />~vi*oln~lud~: Items Cost (each) Sun <br />10~ sq. ~. or less $85,(~ <br />~cb addhkmal 5~ sq. n. <br /> <br />601 amps to 1000 lunps <br />Over 1000 amps or volt~ <br />Reeommet only ...... <br /> <br />200 amps or les.q ~_ <br /> <br /> $50,00 .... 2 <br /> $60.(X) -- 2 <br />$1~),00 ........ 2 <br />$130,00 2 <br />$300.00 2 <br />$40.00 2 <br /> <br />$,~s,00 3.5.0Q <br />$40.00 2 <br />$80.00 ___ 2 <br /> <br />2.00 <br /> <br />$35.00 <br />$ 2.00 <br /> <br />$40.00 2 <br />$40.00 .... 2 <br /> <br />$40.00 --,_ 2 <br /> <br />$35.00 ...... <br />$50,00 <br /> <br /># of Lab~b <br /> <br />5. FEES <br /> Al. Enter total of fees ~111 Sec, #4 <br /> A2, Add 5% surcharge (,05 x A I) <br /> Subtotal <br /> <br /> B, Euter 25% of line. A 1 lbr Phm Review <br /> (Sec, 3), if mqulred <br /> <br /> TOTAL AMOUNT DUE <br /> <br />$3Loo <br />$ 1.85 <br />$_ <br /> <br />~,28.85 <br /> <br /> <br />