ELEC - 1616439 - Laserfiche WebLink

Home Browse Search

FOR C~Y USE ONLY 3150 L~c~er Dr. NE - Suite C ~ R~eiv~ By: Date: · ~ ..... S~em, ~egon 97305 ~ ~n ~ By: .C y: ~, 8:00~- 4:3~m 24 HR Ins~cfion Line 373-~27 F~ 588-7~8 ~di~,: Amount:$ AUG 1 7 1999 ...................................... ~ARION COUN~,~ ~E SCHEDULE (~p~ and en.r t~l in Al) ELEC~CAL PE~ ~PLICA~O~ILDIN~ IN$~EGTI~N ~u~ o~x~in~, ~= ~it al~o~ ~ I Hease complete a~ Sec~, 1 thmugh 5 / · n. R~e.~l Per Uffit Se~ce ~clud~= Items Cost (each) Sum 1. LOCATION OF INSTALLATION Pamel ID: site^d~,s:fZ4. A"3t-f IV~ kCc4fie..l ~,,--'~, City:AL,d'~t~t' ZiP: ~2 Phone: g~ -5777 Cross Street/Directions: PERMITS ARE NON. TRANSFERABLE AND EXPIRE IF WORK IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE OR IF WORK IS SUSPENDED FOR 180 DAYS. 2A. CONTRACTOR INFORMATION Mailing Address~ ~,~ City: FO ~ ~ Sm~: O~ Zip: Contractors Board No.: J Ol~' ~1:~ ~I Contractor Lioense No.: ~/-4 --~.~ IO~,.~ Supervisor License No,: ~g{ q ~ Signature of Supervising Electrician: ~ 2B. FOR OWNER INSTALLATION Property Owner:. (please print) Mailing Address: City: State: Z~p: I am the PROPERTY OWNER and own, reside in, or will reside in the completed structure and will be my own general contractor. 1 understand that l must register as a construction contractor if tbe structure is soM or offenzd for sale before or upon completiot~ lf l hire subcontractors, I wilt hire only subcontractors registered with the Construction Contractors Boant. If I change my mind and do hire a general contractor who is registered with the Construction Contractors Boan~, I will immediately notify Marion County of the name of the contractor Owner's Signature: "3. PLAN REVIEW SECTION Marion County does not require a plan review. We will provide plan review service if you complete Section 5B and submit two (2) sets of plans and specifications with this application. Each additional 500 sq. ft. or portion thereof __ x $20.00 = $ -- Limited Energy -- x $30.00 -- $ -- I Each Manufaclured Home or Modular DwalUng S~rvice or Feeder -- x $52.00 = $ -- 2 B. Services or F~eders (Does not include branch Circuits, see section D) Installation, Alteration or Relocation 200 amps or less il x $65.00 =$ 201amps to 400 amps __ x $80.00=$__2 40l amps to 600 amps -- x $130.00 = $ __ 2 60l amps to 1000 amps __ x $170.00 = $ -- 2 Over 1000 amps or voles -- x $390.00 = $ -- 2 Reconnect Only __ x $55.00 = $ 2 Installation, Alterations, or Relocation 200 amps or less __ x $45.00 = $ 2 201amps to 400 amps __ x $55.00=$___2 401ampsto600amps -- x $110.00=$ 2 Ova 600 amps or 1000 volts see '!B" above New, Alteration, or Extension Per Panel a) The fee for branch circuits with tbe Each bmneh circuit I O x $3.00 = $ ~ b) The fee for branch circuits without the pumhase of Service or Feedet Fee: First branch circuit -- x $50.00 = $ Each additional branch cffcuit -- x $3.00 = $ E. Miscellaneous (Service or Feeder Not Included) Each pump or i~igatinn circle __ x $55.00 = $ -- 2 Each Sign or OutUne Lighting __ x $55.00 = $ -- 2 Signal Ckcuit(s) or a Limited Energy Panel, Alteration or Extension x $55.00 = $ -- 2 F. Each additional Inspection over the allowable in any of the above, per inspection -- x $50.00 = $ __ G. Minor Installation Labels Pack of 10 labels @$10.00 each __ x $100.00 = $ __ (Sold only to F3ectlical Contractors) H. Industriel Plant -- x $62.50/hr = $ __ Onarl~oFamllylh~lllngFee:Sq. Fect -- x $ .09=$__ Dwelling Permit Labels (For$ingle Family Dwellings Only) N/C OTHER, as ~nluired by the Building Official $__ TOTAL $ -- S. FEES A 1. Enter total of fees from Sec. ~ A2. Add State Surcharge (,¢ff% x Al) .0'1 SUBTOTAL B. Enter 30% of line A1 for Plan Review C. Investigation Fee (if required) D. Reinspecfion Fee ($50.00) E. Additional Plan Review ($62,50/hr, minimum one-half hour) E Inspection for which no fee is specifically indicated, ($62.50/hr, minimum one hour) G. Inspection Outside Normal Business Hours, ($62.50/hr, minimum two hours) H. Industrial Plant ($62.50/hr) TOTAL AMOUNT DUE $ /g,oa $__ $__ $ $__ $__ $__ $__ MC 15-34 Rev 9/98