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FOR CITY VALIDATIONI <br />Received by: I <br />i ])ate: ] <br /> <br />285 Church St NE Room 132 A. ~ Illl <br /> <br /> Date: <br /> ~ hr. Insp~tion Line 373~27 <br /> r~: sss-~4s msu~ oy: , ,,voP~CT[O[v <br /> <br /> ELECTRICAL PERMIT APPLICATION <br /> Please complete all Sections, I through <br /> <br />Directiom <br /> <br />PERIffiT$ ARE NON-TRANSI:ERABLE AND EXPIRE IF WORK IS NOT <br />STARTF. D WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK I$ SUSPENDED FOR 180 DAYS. <br /> <br />2A. COHTRACTOR I~STALLATION ONLY <br /> <br />Parkin Electric, Inc. 20250 S Molalla Ave <br />Oregon Cily, OR 97045 503-657-4958 <br /> <br />Contractors License #: 34-4C <br />Supervisor~: 4241-S <br />Contractors Board Reg: 35151 <br /> <br /> I Signature of Suparvizin, Ele~tdcian ~~ <br /> <br />2B. FOR OWlq~R. INSTALLATIONS <br />P~opexiy Owner (p/e~ print) <br /> <br />Msilin~ Addxces [ Phone <br /> <br />Ci~/StatoJZip <br /> <br />O~ner's Signatu~: <br /> <br /> PLAN'REVIEW SBCTION <br /> <br />Marion 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 />4. ~[[E SCH~[DUI~ (Complete and e~tar total in Al below) <br /> Nvinb~r of ~fions p~ ~mit <br /> R~d~t~[ <br /> Unit <br />~vi~ in~d~: lle~ ~t (each) <br />1~ ~. ~ or l~s $85.~ <br />~ ed~t~ 5~ sq. fc <br /> or ~on ~e~f $15.~ <br />Limlt~ ~ $20.~ <br />~ch M~f~m~ H~e ~ Mo~lar <br /> ~cll~g Semite or ~ ~ <br /> <br />C. Temperary 8re'vices/Feeders <br />Installation, Alter atinn, m~ ReJoeation <br />200 nmps or less $35.00 -- 2 <br />201 aml~ to 400 aml~ $40.00 2 <br />401 ampa to 600 ampa $80.00 2 <br />Ov~ 600 ~®aps or t000 volta <br />8~e #B' above <br />D. Branch Circuits <br />Nmv, Alterations. er Exte~ainn Pe~ Panel <br />a) The fee f~ branch clrcuit~ ~ <br />purchase of ser~i~0 of feeder <br />Each branch circuit $ 2.00 -- <br /> <br />b) The fe~ for branch ci~uit~ y~ithout <br /> · <br />First branch circuit <br />Each additional branch circuit <br /> <br />$ 2.00 <br /> <br />E. Miscellaneous (Servioem' Feeder Not Included) <br />Eac,~ pump or k~igatio~ circle $40.00 __~ <br />Each sign or outline lishting $40,00 -- 2 <br />Signal circuit(s) or a limited energy <br />panel, alteration or extension $40.00 2 <br />F. Each additlonal Inspection <br />Over the ellowable in any of the <br />~ove, par lmpection $35.00 -- <br />O. Minor Installation L~bela <br />Pack of 10 labels @ $5.00 each $50.00 -- <br />(~ffd on~y to ele~ttia~ ! ¢ontractor~) <br />H. Other <br />(As required by Bnildillg Offt¢~O <br />Aurora Dwelling EIc~tricel Fee <br /> Dwelling Permit Label N/C <br /> <br /> sq. fi. x $.068 = <br /># of Lahels. <br /> <br />5. FEES <br /> A 1. Enter total of fees from Sec. tq <br /> A2. Add 5% surcharge (.05 x Al) <br /> Subtotal <br /> <br /> B. Enter 25% of line Al for Plan Re¢~ew <br /> (Sec. 3), if required <br /> C. Investigation Fee (if required) <br /> D. Reinspe. ction Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br /> Receipt No, <br /> <br />MC 15-341/96 <br /> <br /> <br />