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03/'14/96 15:17 ~503 588 7948 <br /> <br /> I~~uUNT'Y BUILDING,INSPECTION <br /> N.,I~.~Y OEVELOPMEN'I CENTER <br /> <br />R~eiv~ by: I ~[B ~ ~ ' <br /> ' -" Date. <br />Dam , Bffi ' <br /> ~i~x*"--'- ~~ 588-5147 8:O0am - 4:30pm , __ <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through <br /> <br />P£RMITS AR~ NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT <br />STARTED W/TmN ! 80 DA Y S OF ISSUANCE OR IF <br /> WORK 18 SOSPENDED FOR 180 DAYS. <br /> <br />CONTRACTOR INBTALLATION ONLY <br /> <br />liB. FOR OWNER LNSTALLATION8 <br /> <br />P~op~ly Owner (p/ease prig) <br /> <br />Mailing Address <br /> <br />Owner's SJsnat ute: <br /> <br />3. PLANRIiVIEW SECTION <br /> <br />Maflott 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 />meclficaliong with this applicalion. <br /> <br />4. FEE SCHFIDULE (Comple!e and ent~' tolsl in Al below) <br /> <br />A. <br /> Unit <br /> <br />200 ranim or less $50.00 . 2 <br />201 ntai~l lO 400 amps $~.[10 .. 2 <br /> <br />Temp~sry <br />~ m]l~ or le~ $33.00 .~ 2 <br /> <br />a) ~le f~o f~ brach ciroui~ ~h <br /> <br /> b) ll~e rce rca'lnancb circui~ wilbout <br /> lr~t~huse of scrvic~ et re.e~ltt.l~t <br /> <br />F. Each addilkmal Insp~lion <br /> <br /> above, per h~spe¢lion .... $35.00 <br /> <br />A I. E, ter total of t'e~ from 8cc. fi4 $ ~ ~-~ <br />A2, Add 5~ aut~harge (.05 n Al) $~ <br /> 8ubtmal $.~ <br /> <br />B, ~a~t er 25% ~ line A 1 for Plnn Raview <br /> <br />C, lnveslignt~n Fee (if requi~d) $~ <br /> <br /> v~,c ~oum' mm s ~.7~ <br /> Receipt No ............... <br /> <br /> <br />