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COMMUNITY DEVELOPMENT CENTER <br /> 285 Church St NE · Room 132 <br /> VALIDATION[ Salem, OR 97301 PERMIT NO: <br /> ]FOE <br /> CITY <br /> <br /> ! 24 hr. Inspecnon Line 373-4427 S'~ · It'nj I {'-' <br /> Office: Phone 588-5147 8:00am - 4:30pm tlIJ d.~ )~..~ Jl ~ fY)c>. <br /> FAX: 588-7948 ~-od ~y .n~ (~ <br /> I ocr . <br /> Please complete ali Sections, 1 through 5.I 4. FEE $CHl~tnS~,~da; :ff.!~?~ in -~.~ow)--~ - ~,,, ~.. ~,~ ,, <br />.-. _ _.~.~ - v'~_ f ,I.n~_s~.l~ ~t ~ Sr~'~ permit allowed <br />l. LOCATION OF IN'EY3kLLATIO, ' %gqq ~ A. ~e~idceentlina~,~,. "~ [/¥~lgg?,-~Cl/-~r~t(each) Sure I <br /> 1000 sq. ft. or less ~/'~/V $85.00 <br />Job Addrcss q~,')a V(~' ~' :;~ ~q Each additional 500 sq. ft. <br /> or portion thereof $15.00 <br /> <br /> - - Each Manufactured Homo or Modular <br />Cross gtreeCDir~ctlons: Dwelling Service or Feeder $40.00 -- <br /> <br /> B. Services or Feed~z (Does not include branch ¢ircui~ see section D) <br /> <br /> PERMITS ARE NON-TRAHSFF_RABLE AND EXPIRE IF WORK IS NOT <br /> STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br /> 2A. CONTRACTOR INSTALLATION ONLY <br />I <br /> <br />Parkin Electric, Inc. 20250 S Molalla Ave. <br />Oregon City, OR 97045 503-657-4958 <br />Contractors License #: 34-4C <br />Supervisor: 4241-$ <br />Contractors Board Reg #: 35151 <br /> <br />Signature of Supervising Electrician <br /> <br />,Sapervisor'$ Liceme No. <br /> <br />{ Phoneg <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br />Property Owner (plamse pdm) <br /> <br />Mailing Address I Phone <br /> <br /> City/State/Zip <br /> <br /> Owner's Sigatur~: <br /> <br /> 3. PLANREVIEW 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 15-341/96 <br /> <br /> 401 amps to 600 amps <br /> ~01 amps to 1000 amps <br /> Over 1000 amps or voltz <br /> <br /> C.Temporary ~efvieesiFeedecs <br /> <br /> 200 amps or less <br /> <br /> a) The fee for branch cir~uit~ ~ <br /> nurehase of service of feeder fee <br /> Each branch circuit <br /> <br /> b) The fee for branch circuits without <br /> FirSt branch circuit [ <br /> <br /> E. Miscellaneou~ (8ervle~or Feede~ Not Included) <br /> Each pump or inigntion circle <br />I sign or lighting <br /> Each <br /> Signal elrcull(s) or a limited energy <br /> <br /> Over the allowable in any of the <br /> <br /> Pack of 10 labels @ $5.00 each <br /> (sold only to electrical contrzctors) <br /> <br /> (As reqinred by Buil~g <br /> <br />$50.00 2 <br />$60.00 2 <br />$100.00 2 <br />$130.00 2 <br /> <br /> $40.OO -- 2 <br /> <br />$35.00 2 <br />$40.00 2 <br />$80.00 2 <br /> <br />$ ZOO <br /> <br />$ 2.00 <br /> <br />:$40.00 -- 2 <br />$40.00 2 <br /> <br />$35.00 <br /> <br />$50.00 <br /> <br /> sq. fl. x $.068 =__ <br />#ofLabels <br /> <br />5. FEES <br /> A 1, Enter total of fees from Seg, #4 <br /> A2. Add 5% surcharg~ 605 x Al) <br /> ~ubtotal <br /> <br /> B. Enter25% of line Al for Plan Review <br /> (Sec. 3), if r~quited <br /> C, Investigation Fee (if required) <br /> D. Reinspection Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br /> Receipt No. <br /> <br /> <br />