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Salem, On gon97301 ~ A'.JD 9 t991
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<br />ELECTRICAL PERlt~'r APFUCATION
<br />P,~ase ~ornp/ete a//~ns, 1 ~hrough 5
<br />
<br />Phone 588-5147 8:00 a,m,, - 4~0 p m.
<br />C_x]d~.A-pho~e: E,88-Tg04
<br /> FAX: 588-7948
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<br />~ OONTRACTOR Ii~S'TALLA1]ON (~,ILY
<br />
<br />Mailing Address
<br />
<br />Property Owner
<br />
<br />Contractor's License No,
<br />
<br />Contraotor'~ Board Rog, No, I Job No,
<br /> I
<br />"Signature o~ Supervising Electrl'~i'a'n'
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<br />SupervlsoC8 License No, I Phone No,,
<br />2R FOR OWNER INSTAI. LA~
<br />
<br />Property Ow~ J/L//,~ d~ Y,,
<br />
<br />The In~llation Is being made on proper~ i ~n which 18 not in[ended ler ~le,
<br /> ~neCs Slgnatut ~
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<br />SITE ~I~/IARION COLJN~'~rmlt No.
<br />
<br />issued by::
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<br />4. FEE SCHEDULE (Complete and enter total in A1 below)
<br />Number of leepeefl~ns per permit all.wed
<br />
<br />A. Residential, Slngleor Item= x C43st; Total
<br />
<br />Multi-Family per dwelling unit
<br />( $ervice included)
<br /> 1500 sq. ft oHess
<br /> Ba~h add"1500 sq ft. or portion
<br /> Each Mfg.*d Home or Modular
<br /> Dwelling son,lee or feeder
<br />
<br />B..~ervlee/Feedors
<br />(70 Branch C~rcu/~s
<br />Ir~tellaEon, Alte~ons or Reloc~ffon
<br />
<br /> 100 amps or less
<br /> 101 amps te 400 aelp~
<br /> 401 amps te 600 amps
<br /> 601 aml~ le 1000 amp~
<br /> Over 1000 emps or volts
<br /> Reoonnect Only
<br />
<br />co Temporary ,Ser~iees/Fe~lers
<br />tos~llaEon, Alteration or Reloc.~#on
<br /> 200 amps or less
<br />
<br /> 4ol amps m 6oo ampe
<br /> Over 600 amps of 1000 volts (See 4B)
<br />
<br />D, Ekarmh Clroulte
<br />NeW, Altera~n or Extension Per
<br /> One simuit
<br /> Two te ten drc~JltS
<br /> Each add'I ten circuits or porlion
<br />
<br />F_ MIs~-eltsneous
<br />(Sen,,~-e or Feeder not included)
<br /> Each pump or Ir~cjatlen cyole
<br /> Each sign er outline lighting
<br /> Signal cimult(e) or a limited energy
<br /> panel, alteration or extsns~on
<br />
<br />F, I~aeh edd*l ihepe(:flon
<br /> over the allowable in an), of
<br /> the above, par
<br />
<br />G, Minor tostelletton Lei)els
<br /> Peek of 10 labels @ $500 each
<br /> (Sold on~y to elec~ical co~tradiom)
<br />
<br />H. Other
<br /> (As ~quimd by Building
<br />
<br />$ ts.
<br />
<br />__ $ 3s,, __ 2
<br />
<br />T$ o 2
<br />__ $ ~o,, __ 2
<br /> $130. 2
<br /> ~g]. 2
<br /> $35. ~
<br />
<br />__$,5O.__ 2
<br />$ 15, 2
<br />
<br />$36. 2
<br />
<br />$36. 2
<br />
<br />__$35.
<br />
<br /> $,50.
<br />
<br />3. PLAN REVIEW SEC3K3N
<br /> Che~k appropriate item and enk~r fee in Eec#on 5B.
<br />
<br />Connec, ted Load over 200 amps (exae~ single family dwellings)
<br />Building system over 200 amps (except single fami~ dwellings)
<br />System Over 600 volts
<br />Building over 2 stodes
<br />Building over 10,000 square feet
<br />Occupant load over 300 persons
<br />Manufactured Dwelling PanVJRann~fion Park
<br />Hazardous Locations
<br />
<br />Submit ::' t, ets of plans wi~ any of the above,,
<br />Temporal7 constn.,~Jon services do not apply,,
<br />
<br />5. r~-~ Al. Enter ~)tal of fees fi-om SOo. ~
<br /> ~. ~~ (.05xA~)
<br />
<br /> Subto~
<br /> ~n R~i~
<br /> (~c. ~). if ~uir~
<br /> C. In~s~ F~ (~ ~imd)
<br /> D, R~n~n ~ ($~,~)
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<br /> TOTAL A~UNT DUE
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