Laserfiche WebLink
IFOR. OFFICE USE ONLY I MARION COUNTY BUILDING INSPECTION <br /> Date: { Salem, Oregon 97301 <br /> Phone 588-5147 8:00 mu - 4:30pm <br /> <br />I <br /> Please complete all Sections, I through 5~_L~ ' . ~ ~qo,7 -~ Issued by' <br /> :': ~ ..1UU! ' <br /> <br /> Aurora { c~, ~ <br />D~fi~, Stop at office for directions <br /> <br />D~,c~MionReplace meter base in pump house <br /> <br />pERMITS ARE NON-TRANSFERABLE AND NON-REFUNDABLE AND <br />EXPIRE IF WORK IS NOT STARTED ~ 1~0 DAYS OF ISSUANCE <br />OR IF WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />~A. CONTRACTOR INSTALLATION ONLy <br />Elem~mCon=~cmr Dryden Electric Ind.Ph°ne 981-3913 <br /> <br />M~lmgAdd~PO Box 266, Hubbard OR 97032 <br /> <br />P~ °wn~rEdelweiss Farms <br />Co.tac~or% ~,cNo. 24-322C <br /> <br />con~c~fs Boa~ ReS. No. 98943 <br />Signature of Supe~dsing I~ectfic~an <br /> <br />S~ervisofs Lieense No. 31388 <br /> <br />TPho"¢ 678_2156 <br /> <br />{~ob No. <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br />Propsny Owner <br />Maging Addrezs Phone <br />City/StatefZip <br /> <br />'She insmllmio~n is being made on property I own which is net i~ter~ded for sale, <br /> <br />Owner's Signature <br /> <br />3. PLAN REVIEW SECTION <br /> <br />We will provide plan review service if you Complete Section <br />5B and submit two (2) sets of plans and specifications wifia <br />this application. <br /> <br />This optional plan review program does not suspend thc <br />required submission of fighting 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 />IN,( <br /> <br />Nu' ' °f I"sPfj°n s Parc~PS~rnl2: all°:] <br /> $85,00 4 <br /> $15.00 <br /> <br />Limited Energy $20.00 1 <br />E~.h Manufd Home or Modular <br />Dwelling Service or Feeder $40.00 2 <br /> <br />B. Sel'~ees or Feeders (Does not inlcudc branch circuits, see section D) <br /> <br /> Installation, Alterations m- Rdocatlon <br /> 200 aml~ or less <br /> 201 amps to 400 amps <br /> 401 amps to 600 amps <br /> ~01 nmp~ to 1000 amps <br /> Over 1000 amps or volts <br /> Reconnect c~ly <br /> <br />C. Temporary Services/Feeders <br /> Installation, Alteration, or Relocation <br /> 200 amps or less <br /> 20! ~.~ps to 400 amps <br /> 401 amps m 600 amps <br /> Over 600 amps or !000 volts <br /> <br />D. Braneh Clrcutiz <br /> New, Alteration, or Extension Per Panel <br /> <br /> s) The fee for branch dtcults <br /> uurcha~ of servlee or feeder fee <br /> <br /> r~ch branch circuit <br /> <br /> b) The fee ~or branch clrcuts without <br /> ~hase of semdce or re. oder fee <br /> <br /> Fire branch clrc~ <br /> l]ach ad&fional b~mch circuit <br /> <br />E. Mlseellaaeo~s (Service or Fe~ler Not Included) <br /> <br /> S~) drcuk(s) or a limitod <br /> Psn~], alteration or extension <br /> <br />F. F~ch addi~nal lmpectl~ <br /> over th~ allowabl~ in any of the <br /> <br />G. Ml~or lastallation Labels <br /> Pack of 10 labels @ $5.00 e~ch <br /> (~old oaly to electrical coatr~ctor~) <br /> <br />H. Other <br /> ~ A~ required by Buildin~ Official) <br /> <br /> ~:0~0 50.002 2 <br /> 100.00 2 <br />130.00 2 <br />300.00 2 <br />$40.00 , 2 <br /> <br />$35.00 <br />$40,00 <br />$80.00 <br /> <br />$2.00 <br /> <br />$2.00 <br /> <br />$40.00 <br /> <br />$40.00 , 2 <br /> <br />$35.00 <br /> <br />5. FEES <br /> Al. Enter to~d of f~s frcm Sec. #4 <br /> A;L Add 5% surcharge 605 x Al) <br /> <br /> B. Enter 25% of lineAl for Plsn Review <br /> (Sec. 3), if ~quired <br /> C. I~vegigat~on F~ (if required) <br /> D. R~.inSl~Ctim Fe~ (325.00) <br /> <br /> TOTAL AMOUNT DUE <br /> <br />50.00 <br />~. 5¢) <br /> <br />52.50 <br /> <br />$52.5O <br /> <br />Rece~x No. <br /> <br /> <br />