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R ~O' ~ MARION COUNTY~UILDING INSPECTIOJ~ R OFFICE USE ONLY Da~' ~' ~em, ~g~ F~. 588-7~ .8 ELECTRICAL PERMIT APPLICATION I Date: Please ~mplete afl Se~lons, I throu h 5 ~ 1. LOCATION OFINSTALLATION JobAddress 14452 ARNDT RD NE city q7flO? AURORA I Cro. St. IN~fions COLUMBIA HELICOPTER DATA/PHONE LOW VOLTAGE INSTALLATI PERMITS ARE NON-TRANSFERABLE AND NON-REFUNDABLE AND EXPIRE IF WORK IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE OR IF WORK IS SUSPENDED FOR 180 DAYS. 2A. CONTRACTOR INSTALLATION ONLY ElectricalC~tractorCHRISTENSON ELECTRI~k~'t~C 241-4812 MuilingAddre. 111 SW COLUMBIA,SUITE 480 VmpsnyOwner PORTLAND OR 97201-5~fi~e C~tractoes Lieense No. 26-34C Contractefs Board Reg. No... 00458 11°hN°'509-7968 Signature of Supervis~ectrlci Supslvisor'sllcenseNo. 873S IPbo"eN°' 241-4812 2B. FOR OWNER INSTALLATIONS Pmpsny Oum~ Mailing Address Phone City/State/Zip The installation is being mad~ on pro.ny I own which is n~X intea~ded for sale, Owners Signature 3. PLAN REVIEW SECTION We will provide plan review service if you complete Section 5B and submit two (2) sets of plans and specifications with this application. This optional plan review program does not suspend the required submission of lighting power calculations, plans, and specifications when required by the Oregon Structural Specialty Cede, Chapter 53. MC 15-34 11/91 4. FEE SCHEDULE (Complete amd enter total in Al below) Number of Inspections per permit allowed ---] A. ReMdentlal Per Unit / Service Included: Items Cost (each) Sum/ 1000 sq, fL or less $85.00 -- 4 Each ad&fional 500 sq. ft. orix)m<'on thereof $15.00 ~a En~r~ $20.00 __ 1 Each Manufd Home or Medolar Dwelling Serdce or Feeder $40.00 B. Services or Feeders (Does not uilcude branch circuits, see section D) Installation, Alteratloas or R~io~atlon 200 aml~ or less 201 amps m 400 amps 401 aml~ tu 600 ~mps 601mnips~ to 1000 aml~ Over 1000 amps or volt~ Reeommct c~ly C. Temporary Servlce~Feed~rs Installation, Alteration, or Relocation 200 amps or less 201 amps to 400 a,rnps 401 amps to 600 amps Over 600 amps or 1000 volts SM "B" abovg D. Brach Circuits New, Alteration, or Extension Per Panel a) '[he fee for branch circuits wi~ uurchase c~ service or feeder fee Each branch circuit b) The fee for branch circms without m~rchasc of scn4ce or feeder fee First branch cimuit Each additional branch circuit E. Mfscellaneous (Service or Feeder Not Included) Each s~n or c~tli~ lighting Signal circuit(s) or a limited energy panel, alteration or extemion F. Each additional Inspection over the allowabl~ in any of the above, per Inspection G. MInorlnsiallatlon Labels Pack of 10 labels @ $5.00 each (sold only to electrical contractors) H. Other (As required by Buitdi~g Offi¢ia0 I50.00 -- 2 60.00 2 $100.00 2 $130.00 -- 2 $300.00 -- 2 $40.00 -- 2 $35.00 2 $40.00 2 $80.00 $2.00 $35.00 $2.00 $40.00 $40.00 I $40.00 $35.00 $50.00 5. FEES Al. Eater total of fees from Sec. #4 A2. Add 5% surcharge (.05 x Al) Sub~otal B. Enter 25% uiqineAl for Plan Review (Sec. 3),if requirezl C. InvestigationFee (ff required) D. Reinspection Fee ($25.00) TOTAL AMOUNT DUE Receipt No. 40. 2. 42. 42.