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Recetved b~ <br />Date: <br /> <br /> ELECTRICAL PERMIT APPLICATION <br /> Please complete all Sect!ons, i through 5 <br /> <br />Salem, Oregon 97301 iJ~L~ <br /> <br />~-A-~: 588-7~4 Permit No. <br />F~: 588.7~8 SITE ~: <br /> MAR~ON COUNTY <br /> <br /> 18sued <br /> <br />L LOCATION OF INSTALLATION~ <br /> <br />PERMITS ARE NON-TRANSFERABLE AND NON-REFLrNDAB LB AND <br />EXt~IRE IF WORK IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE <br />OR IF WORK IS SUSPBNDED FOR 180 DAYS, <br /> <br />2A. CONTRACTOR iNSTALLATION ONLY <br /> <br />2B. FOR OWNER IN~rALLATIONS <br /> <br />Owner <br /> <br />Mating Address Phone <br /> <br />City/St~m/Z/p <br /> <br />The instalhlion is ~cjng made on property I own which is not ~ntenOed for sale. <br /> <br />Ov~¢fs Signamv* ...... <br /> <br />3. pLAN REVIEW SECTION <br /> <br />We will provide plan review service if you complete SecO, on <br />5B and submit two (2) sets of phns and specifications with <br />this application. <br /> <br /> This optional plan review program does not suspend the <br /> required submission of lighting 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 />d. FEE SCHEDULE (Complete ~d enmr total in A 1 below) <br /> Number of Insp~tlons per ~rmti allowe~ ~ <br /> Residential <br /> Per <br /> Unit <br /> Sc~lce Included: It~ Cost (each) Stol <br /> <br /> or~m ~e~of $~5,00 <br /> <br />~a~ M~d ~e or M~ular <br />Dw~ng Serum or F~d~ $40.00 ~ 2 <br /> <br />g. 8e~ or Feeders ~s not ~lcad~ b~nch cqm~t~. ~ section D) <br /> <br /> ~ ~less $50,00 ~ 2 <br /> ~1 ~ ~ 4~ ~p~ ~ $~0.00 __, 2 <br /> ~l~w6~ps $100.~ ~ 2 <br /> <br /> ~t 1~ ~p~ or vol~ $300,00 ~ ~ <br /> <br />C. ~m~ravy 8ervl~ers <br /> <br /> 2~ ~ps or less ~ $35.00 ~ 2 <br /> 201 ~ps m 400 ~ps ~ $40,00 ~ 2 <br /> 401 ~ps to ~ amps $80,00 ~ 2 <br /> ~c~ ~ ~ps or 10~ volts <br /> <br />D, Branch Circe/ts <br /> <br /> a) Thc fee f0r branch c~r~rdta 2//th <br /> u~so of se~ ~ fe~er fee <br /> <br /> ~ch br~ c~u~ ~ <br /> b) ~e f~ for ~aneh drcms ~i~om <br /> <br /> F~t branch cim~t ~ <br />E, Ml~ellan~os (Service or Feeder Not included) <br /> <br /> (~oM oMy to electr~al comractor~) <br /> <br /> ( A~ mq~red by BuiMing Offlc~O <br /> <br />$35,00 <br /> $2.00 <br /> <br />$40.00 ~2 <br />$40.00 ~2 <br /> <br />$40,00 ~--'- 2 <br /> <br />$35.00 <br /> <br />$60.00 <br /> <br />$, FEES <br /> Al. ~nter total of fees from S¢c. #4 , <br /> A2. Adcl 5% ~urcharge (,05 x Al) <br /> <br /> Subtotal <br /> <br /> B. Enter ~% of l~e A1 ~or Plan Rcv}¢w <br /> (Sec, 3), if reqmred <br /> C. InvesdgallonFee (if required) <br /> D, ReJnspeefim Fee ($25.00) <br /> <br /> '0DTAL AMOUNT DUE <br /> <br />,,,Re~i~No. <br /> <br /> <br />