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Aurora ~ o~s st <br />Dk~dem Call Joe Dryden 981-3913 or 931-1552 <br /> <br />FOR. OFFICE USEO---~ MARION COUNTY BUILDING INSPECTION <br /> <br />Received by:__ _.___ ] 220 High Strut NE <br />Date: ~ Salem, Oregon 97301 <br /> Phone 588-5147 8:00 a~ - 4:30pm <br /> Code.-A.Phc~e: 58~-7904 <br /> FAX: 5~-79~s~ SITE #: <br /> ELECTRICAL PERMITAPPLICA*[0~I'~ q ~'~,-~'-" ~ Date: <br /> -,. . <br />Please complete all Sections, I <br /> Issued <br /> by: <br /> <br /> 1. LOCATION OFINSTALLAT1ON .: ,. ~.,? ~?~.~ 4. FEESCHEDULE (CompleteandeatertotalinA1 below) <br /> <br /> ~ A. Re~d~lttlal Per Unit <br /> Service Included: It.s Cost (each) Sum/ <br /> <br />before inspection <br /> Descdp~onReplace 200 amp service <br /> <br />PERMITS AKE NON-TRANSFERABLE AND NON-REFUNDABLE AND <br />EXPIKE IF WORK IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE <br />OR IF WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br />Ele~dc~Cea~¢m~r en Ee r' In vacua - 13 <br />M~nngAadmssP0 Box 266, Hubbard OR 97032 <br />Pna~nyOwn~Curtis Pahl IPh°ne 981-9088 <br /> <br />ce~um~ofs 1 ic~ No. 24-322C <br />C°nu~$ ~ P~S' N°' 98943 Il No, <br /> <br />Signature of Supervisinll Elecuic~an ~' V'~ <br />Sapervisofs License No. 3138S <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br />Property Owner <br /> <br />Mailing Address <br /> Phon~ <br /> <br />City/~t ate/Zip <br /> <br />The imtallafion ~ being made on proper~y I own which is nat intended for sale, <br /> <br />3. PLAN REVIEW SECTION <br /> <br />We wiU provide plan review service if you complete Section <br />5B and submit two (2) sets of plans and specifications with <br />this application. <br /> <br />This optional plan review program does not suspend the <br />requked submission of lighting power calculations, plans, <br />and specifications when required by the Oregon Structural <br />Specialty Code, Chapter 53. <br /> <br />MC 15-34 11/91 <br /> <br />10~0 sq. ft o~less $85.00 ~ 4 <br />Each additiolm1500 sq. ft. <br />er ponica thereof $15.00 <br />~ Ea~ray $20.00 1 <br /> Each Manufd Home or Modular <br /> Dwelling Service or Feeder $40.00 -- 2 <br /> <br />B. Se'Htms ~- Feed~'~ (Dees not i~lcade branch c~rc~ts, see ~ectkm D) <br /> Im~.alhflem, Alterations ~. <br /> <br /> 201 aml~ to 4~0 amps ~ $60.00 <br /> 401 aml~ to 6fl0 amps <br /> 601 amp~ to 1000 amp~ <br /> Over 1000 amps or volts <br /> Reconnect ~ly $40.00 <br /> <br />$35.00 -- 2 <br />$40.00 __ 2 <br />$~0.00 ~ 2 <br /> <br />$2.00 __ <br /> <br />$35.00 __ <br /> SZO0 ~ <br /> <br />$40.00 ~ 2 <br />$40.00 ~ 2 <br /> <br />$40.00 -- 2 <br /> <br />$35.00 <br /> <br />C. Temporary Servlce~Feed~s <br /> Installation, Almmtinn, or Rdocaflon <br /> 200 mnp~ or less <br /> 201 ~,ps m 400 aml~ <br /> 401 m~ps to 600 aml~ <br /> Ove,r,~,6~0, amps c~ 10(X) vol~ <br /> se~ B above <br /> <br />D. Branch Clrcnlts <br /> New~ Alte~nUon, OF ~xtenMon Per Panel <br /> <br /> a) The fce £ot branch c~c~its wlth eof ' or <br /> <br /> Each branch cln~t <br /> <br /> b) Tbe fee for branch circuts withom chase 'ce <br /> <br /> First bra:~h c~cuit <br /> Each additional branch circuit <br /> <br />E, Mlscellnnceus (Service or Feeder Not Included) <br /> Each pomp c~ inlgafiee cLrcle <br /> Each ~ or omline lighting <br /> Signal c~'ult(s) ~ ~ limited energy <br /> panel alteration or extension <br /> <br />E Each additional lnspectlo~ <br /> over the allowable in any of the <br /> <br />G. Minor InstnBatlon Labels <br /> Pack e~ 10 labels @ S5,00 each <br /> <br />~, Other <br /> <br />5. FEES <br /> A I. Eater t(Xal of fe~s from Se~ #4 <br /> A2. Add 5% surcharge (.0~ x Al) <br /> <br /> Subtotal <br /> <br /> B. Enter 25% of lineAl for PlanReview <br /> (Sec. 3),if mquized <br /> C. inveaigation Fee (if requb~d) <br /> D. Reinspecd~-~ Fee ($Z5.00) <br /> <br /> TOTAL AMOUNT DUE <br /> <br /> <br />