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FOR OFFICE USE ONLY <br />Received by:. <br />Date: <br /> <br /> Salem, Oregon 97301 <br /> <br />Phone 588-5147 8:00 am - 4:30pm <br /> <br />ELECTRICAL PERMIT,APpLICATION' <br />Please complete all Sections~ l through5 <br /> <br />Code-A-Phone: 588-79~4 <br /> FAX: 588-7948 <br /> <br />PERMITS ARE NON-TRANSFeRABLE AND ~TON'-R~FUNDAB LE AND <br />EXPIRE/F WORK IS NOT STARTBD WiTI.L1N i80 DAYS OF ISSUANCE <br />OR IF WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />CONTRACTOR INSTALLATION ONLY <br /> <br />211. FOR OWNER INgTALLATION$ <br />Propeay Owner <br />MaiIing Address Phone <br />C~ty/$tate/Zip <br /> <br />The ins[alla6.on is being made on prolmny I own which is ncl intended for sale, <br /> <br />3. PLAN REVIEW SECTION <br /> <br />SITE #: .......... -,Pg, r,m, J!, N°' <br />Issued by: <br /> <br />4. FEE SCHEDULE (Complete end ~ntcr total in A 1 below) <br /> <br /> Number of Inspections per pemit allowed <br /> <br />A. R~identlal Per Unit <br />Scm'ice Included: Itea~ls Co~t (each) <br /> <br />10~ sq. ~ or less $85,00 <br />E~h ad~fi~al 5~ sq, ~. <br />~ ~ thcr~f ~ $15.00 <br />~d Ene $~.00 <br />Ba~ Ma~C or M~ular <br />Dw~ Sc~m or Feed~ ~ $40.00 ~ <br /> <br />B. Servl~ or Feeders ~s not ~lcude branch cim~ts, s~ sechon D) <br /> <br /> ~1 ~ to 4~ ~ps $60,00 <br /> ~1 ~ to 6~ amps $100.00 <br /> ~1 amps m 1~)0 am~ <br /> ~er 10~ raps or volta $300.00 ~ <br /> Rc~aect ~ly $40.00 ~ <br /> <br />C, Temporary Servlces/Feedera <br /> lnMallatlon, Alteration, or Relocation <br /> 200 amps or le~s <br /> 201 amps to 400 amps <br /> 401 amps to 600 amps <br /> Over 600 amps or 1000 volts <br /> <br /> D. Branch Cireui~ <br /> New, AIt~ation, or Extension Per Panel <br /> <br /> a) Th~ fe~ for bra~ch ci~uits ~ <br /> p~rchasc of scr~ce Or feeder ef~e~ <br /> <br /> ~aeh branch circuit <br /> <br /> b) The fee for branch clrcuts 3xithout <br /> <br /> Each addldonal branch circuit .... <br /> <br />E, Miscellaneous ($er¥i¢e or Feeder Not Included) <br /> · Each pur~p or irrigation cir¢le <br /> Each sign or outline Iii;bring <br /> Signal c~reuit(s) or a limR~d energy <br /> <br />E lgach additional Inspection <br /> over ~he allowabl, in any of thc <br /> above, per Inspection <br /> <br />G. Minor Installation Label~ <br /> Pack of 10 labels @ $5.00 each <br /> (~old oMy to electrical contractor,) <br /> <br />H, Other <br /> ( AS required by Building Official) <br /> <br />$35.00 --2 <br />$40.00 <br />$80.00 <br /> <br />$2.00 <br /> <br />$35,00 <br /> $3.00 <br /> <br />$40.00 <br />$40.00 <br /> <br />$40.00 <br /> <br />$35.00 <br /> <br />$50,00 <br /> <br />We will provide plan review service if you complete Section <br />5B and submit two (2) sets of plans and specifications with <br />th~s 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 Cede, Chapter 53. <br /> <br />MC 15-34 11/91 <br /> <br />5. FEES <br /> Al. Enter toial of fees from Sec, #4 <br /> A2. Add 5% surcharge 605 x Al) <br /> <br /> Subtotal <br /> <br /> B, Enter 25% Of line A 1 for Plan Review <br /> (Sec. 3), il required <br /> C. Investigation Fee (if mquffcd) <br /> D, RctnspecIion Fcc ($25,00) <br /> <br /> TOTAL AMOUNT DUE <br /> <br /> <br />