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Re~elved by:. <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br />COMMUNITY DEVELOPMENT CENTER <br />285 Church St NE - Room 132 <br /> Salem, OR 97301 <br /> <br /> 24 hr. Inspect[on Line 373.-4427 <br />Office: Phone 588.-5147 8:00am - 4:30pm <br />FAX: 588-7948 <br /> <br />IELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through <br /> <br />L LOCATION OF INSTALLATION <br /> <br />Pr~.Mllr5 ARE NON-TRAHSFERABLI5 AND EXPIRE IF WORK I$ NOT I <br /> STARTED WrrH1N 180 DAYS OF ISSUANCE OR 1F <br /> WORK IS SUSPENDED FOR I80 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />Parkin Electric, Inc. 20250 S Molalla Ave. <br />Oregotx City. OR 97045 503-657-4958 <br /> <br />Contractors License #: 34-4C <br /> Supervisorg: 4241-S <br />Contractors Board Reg: 35151 <br /> <br />1sul~ia°e" LiCem* N°' <br /> <br />211. FOR OWNIiR II~,STALLATION$ <br />Propmly Owner (ple~s~ print) <br /> <br />Mailing Address I Phone <br /> <br />Owner's Signature: <br /> <br />3. PLAN REVieW SECTION <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 />MC 13-341/96 <br /> <br />~ssued I~RR!O~! Cnl~lTY <br /> BUILDING INSPECTION <br /> <br />4. l~l[i 8CHEDUL~ (Complete and enter total in A1 ~bw) <br /> Nmnber of ~c~ns p~ p~it allo~ ~ <br /> R~idontinl <br /> Unit <br /> <br />Limit~ ~e~y $20.ffi 1 <br /> ~g Semite or Feed~ ~.~ 2 <br /> <br />B, 8etvioe~ e~ Fzoder s (Does not include branch circuits, s~ a~t~n D) <br /> <br /> ~ amps or loss $~.~ 2 <br /> ~ I ~ to ~ am~ $~.~ 2 <br /> ~1 am~ to ~ am~ $1~.~ 2 <br /> ~1 m~ ~ 1~ ~ps $1~.~ 2 <br /> <br /> Re~ect only ~.~ 2 <br /> <br />C. Tamp or ar y S~vie~aClFe~de~ a <br />ln~taEatinn, Alteration, ~r R~loeatio~ <br />200 amps or less $35.00 2 <br />201 amps to 400 amps $40.00 2 <br />401 amps to 600 amps $80.00 2 <br />Over 600 amps or 1000 volts <br /> <br />D. Branch Circuits <br />a) The fee for branch circuits wi~h ~ <br />Each branch circuit $ 2.00 <br /> <br />E. Miscellaneous (8orvico o~ Foed~ No~ Included) <br />Each pump or ~gation civic ~.~ 2 <br />~ch si~ or outlin~ Ii~fmg $~ 2 <br /> <br />~el, all~tion or extemion ~ 2 <br />F. ~ addltio~l In~t~ <br />Over ~e allowable in ~y of ~e <br />above, ~r ~pection ~5.~ <br />G. MM~ In~t~ ~bels <br />~ck of l0 l~e~ ~ $5.~ ¢nch $~.~ <br /> <br /> (~ r~oired by ~ildi~ O~c~O <br /> Amra Dwelling ElecMcnl F~ sq. fi. x $.068 =~ <br /> ~elHng Pe~it ~bel ff of ~ls N/C <br /> <br />5. FEE5 Al. Enler total of fees from Sec.//4 <br /> A2. Add5% surchargg (.05 x Al) <br /> <br />B. Enter 25% of line Al for Plan Review <br />(See. 3), if required $__ <br />C. Investigation Fo~ (if requited) $__ <br />D. Rcimpec6oa F~ ($25.~) $ ~ <br /> TOT~ ~O~ D~ $~ <br />Receipt No. <br /> <br />~ubtotal <br /> <br /> <br />