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mR crtz v *mA O" } <br /> I <br /> <br /> UARION COUNTY <br /> Date: ,., .......... <br />24 la'. Info. on Line 373-4427 OUlLUIIVb IH~sFt-L;II0,~d <br />Offiee: Phone ~8-S147 8:0O~m - 4:30pm <br /> <br />IELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />I <br /> <br />P~P~,~TS AP~ NON-TI~d~8~,A~ AND ~D~P,E IF WORK 1~ NOT <br /> STARTHD ~ 180 DA'tS OF ISSUANCn OR <br /> WORK IS SUSI~NDE~ FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />Pal~in Elsotdc, Inc. 20250 S Molalla Ave. <br />Oregon City, OR 97045 503~57-4958 <br />Contractors License #: 34-40 <br />Supervisor: 4241-S <br />Contractors Board R~ #: 35151 <br /> <br />~ Ow~ (p~s~pr~) <br /> <br />btaifing Addren I Pimne <br />Owner's Si~flature: <br /> <br /> 3. PLANRBVIBW SECTION <br /> <br />IMarion County does not require a plan review. <br /> We will provide plan review service if you complete <br /> SeCtion 5B and submit two (2) sets of plans and <br /> specifications with this application~ <br /> <br /> MC 15-341/96 <br /> <br />4. I~,~, SC~-i14!~ (Compie, te tn6 mttwtotal in Al below) <br /> <br />A. <br /> Servi~Incbded: lmm ~t(~) ~ <br />l~.fl.~ Im $~.~ 4 <br />~ch~ ~ ~.~ <br /> ~ ~n ~ S <br />~i~ ~ ~0.~ ,, 1 <br />~ M~o~ H~ or ~ <br /> <br />Ina~allatioo. Altm-ation ~ Rdoeatiem <br />200 aml~ or less $50.00 2 <br />201 amps to 400 amps $~0.00 2 <br />d01 amps to 600 amps $100.00 .2 <br />601 amps to 1000 smp~ $130D0 ,2 <br />Over I000 ~voP- $300.00 2 <br />Reconn~t only $40.00 2 <br /> <br />$~.00 2 <br />~0.00 2 <br />$~0.00 ,.2 <br /> <br />$ ZOO -- <br /> <br />b) The foe for blanch ci~uita willmm <br /> / <br />Ftrst branch ckcult $35.00 __ <br />~ach additional brnnch c~rcult $ 2.00 <br /> <br />E, Mimdlaneoas (Servlee ~ Feedee Not ~dM) <br /> ~ p~ ~ ~a~ c~le ~ 2 <br /> <br /> ~lO~b~m~ <br /> (~ ~ ~ ~sl ~) <br />H. 0~ <br /> <br /> A~m ~elli~ ~cal F~ ,vq. fl. x $,068 = <br /> <br />FEES <br />Al. ~ to~al of fees from Seo. ~4 <br />A2. Add 5% suroha~o (.05 x Al) <br /> <br />~btotal <br /> <br /> <br />