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FOR CITY VALIDATION <br />Received by: <br />Date: <br /> <br /> 285 Church <br /> <br /> Date: <br /> 24 Hr Inspoetion Lin~t~l~tC0L~ffT~ <br />offs: sss-s~4? s:~1411~lM°~'~°cr"n'~Lued------.-- .,.,--,-,,-t~ss <br /> by: <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />Directions <br /> <br />Description <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT <br />STARTED WITHIN 180 DAYS OF ISSUANCI~ OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />Parkin E{ectdc, {nc. 20250 S Molalla Ave. <br />Oregon City, OR 97045 503-657-4958 <br />Contractors License #: 34-4C <br />Supervisor: 4241.$ <br />Contractors Board Reg #: 35151 <br /> <br />]Signatme of Supervising Electrician <br /> <br />2B. FOR OWlqTaR INSTALLATIONS <br />P~perty Owner (pleasepfint) <br /> <br />Mailing Address I Phone <br />City/State/Zip <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 />qbo 75 2c/ <br /> <br />4. ]~EE SCHEDUL~ (complete and ente~ tolal in Al below) <br /> <br />A. Residential Per Unit Number°fl~sl~cti°ns p~ p~emit allowed ~ <br />~ln~d~: I~ C~t(~h) S~ I <br />1~ ~. fl. ~ l~n $85.~ 4 <br /> <br /> ~f $15.~ <br />~iled ~y $20,~ 1 <br />~ch Ma~f~m~ Hom~ or ModMar <br />~l~g ~ or Fcc~ I ~.~ ~O ~ <br />B. ~v~ F~a (~ not inelu~ ~eh ei~ui~ ~ ~t~n D) <br /> <br /> iastadhfm, Alte~ ati~ ~ Rel~mtiou <br /> 200 amps or leu $50.00 2 <br /> 201 amps to 400 amps $~0.00 2 <br /> 401 limps to 600 amps $ t00.00 2 <br /> 601 amps to 1000 amps $130.00 9 <br /> Over 1000 amps or volta $300.00 - 2 <br /> Reconn~t only $40.00 2 <br /> <br />C. Temporary Seevi~M/Feedets <br />Installation. Alteration, ne Relocation <br />200 amps or less $35.00 -- 2 <br /> 20t ~mps to 400 ~mps $40.00 2 <br /> 401 amps to (~0 amps $80.00 2 <br /> Ov~ 600 ampa or 10C0 volt~ <br /> <br />D. ~anch cireu~s <br /> New, Alterations, m' Extension per Panel <br /> a) The fee for branch eirculta ~ <br /> <br /> Each brsnch circuit $ ZOO <br /> <br />b) The fee for branch ~:ircuit$ without <br /> <br />Fi~t branch circuit <br />Each additional branch clr~int <br /> <br />$35.00 <br /> <br />E. Miscellaneous (Servleeor Fe~ler Nm Included) <br />Each pump or iolgation circle $40.00 2 <br />Each aign or outline lighting $40.00 2 <br />Signal circuit(s) or a lhnit~d energy <br />panel, alteralion or ex~nsiofl $40.00 2 <br />E, Bach additional Inspection <br />Ovcr tbe allownble in nny oflhe <br />a~v~, par ln~p~.ion $35.00 <br />O. Miner inst~llation Labels <br />Pack of 10 labels @ $~i.O0 each <br />(Mtd only to electrieM <br />H. Other <br />(A~ required by B~i/d~g <br /> Am~ara Dwelling Ele¢lricnl Fcc __.sq. fL x <br /> Dwelling Permit Label g of Labels N/C <br /> <br />FEES <br />Al. Ent~r~lal oft'~esfix~mSe~. ~ $ k~C) ~O <br />A2. Add 5% s~ha~ (.0Sx Al) $~= <br /> <br /> B, ~ter 25% of IMe A1 for PI~ R~iew <br /> (S~c. 3), if roqui~ $__ <br /> C. lnv~tigation Fee (ifr~uimd) $__ <br /> D. Rei~pection Fee (S25.~) $ <br /> ~ ~O~ D~ $C/~ <br /> R~ipt No. <br /> <br />MC 15-34 12./94 <br /> <br /> <br />