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FOR CITY VALIDATION] <br />Received By: <br /> <br />Date: <br /> <br />BUILDING INSPECTION DIVISION <br /> 3150 Lancaster Dr. NE - Suite C <br /> Salem, Oregon 97305-1398 <br /> <br /> 24 HR Inspection Line 373-4427 <br />Office: phone $88-5147 8:00am - 4:30pm <br />FAX 588-7948 <br /> <br />IELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, 1 through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br /> JO~ADDP~SS 11912 Steinkamp Rd. <br /> CITY Aumsville <br /> <br />PROPERTY OWNER Mike Kline <br /> <br />CDiR~O~Sc~SoTN~ET/ Golf Club Rd. off Hwy 22 <br /> <br />PROJECT DESCRIPTION wire new garage <br /> <br />IPERMITS ARE NON-TRANSFERABLE 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 /> <br />Electrical Contractor Daveken Electric Co. Inc. <br />MMlingAddrcss P.O. BOX 604 ClWSta. rton <br /> <br />Pho.~ 5 0 3 -- 7 6 9 7 3 5 7 <br />PAX ~ .. <br /> <br />Contractors License No. 2 4 -- 3 2 7 C <br />Contractor Board Reg No. ) '] 0 1 5 6 I <br />Supe.i orLice , / ( f' f,/ S <br />Signature of Supv. Eleclrician ~ ~9~.'"~g.~'~ <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br /> Property Owner (pleo~e prin0 <br /> <br /> Mailing Address <br /> <br /> City, State, Zip <br /> <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 />MC 15-34 7/97 <br /> <br />Date: <br /> <br />Issued by: <br /> <br />4. FEE SCHEDULE (Complete and enter total in Al below) <br /> <br />A. Residential Per Unit Numbe~ ° f lnspecti°ns P~rt I:ermit all°wed -~ <br /> Service Included: Items Cost (each) Sum <br />1600 sq. fc or less $85.00 4 <br />Each additional 500 sq. fi, <br /> or po~on thereof $15,00 <br />Limited Energy $20.00 1 <br />Each Manufactured Home or <br /> <br /> 200 am~ o~ tess ~ Sso.oo ~ 2 <br /> Each branch alrcuit ~ $2.00 ~ <br /> <br />5. FEES <br /> A L En~r total of feez from Sec. #4 <br /> A2. Add 5% sur~har~ (.05 xAl) <br /> <br />B. Enter 25% of line A 1 for Plan Review <br /> (Sec. 3), ff required <br />C. Investigation Fee (if requ~d) <br />D. Rein~pection Fee ($25.00) <br /> <br />Receipt No. <br /> <br />Subtotal <br /> <br /> <br />