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FOR OFFICE USE ONLY <br />R¢ceLved by <br />Date: <br /> <br /> 220 High S~t ~ <br />Sal*m, ~g~ 9730 <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, 1 through 5 <br /> <br />I, LOCATION OFINSTALLATION <br /> <br />PgRNfrl'$ g2&II NON.'I'R,AN$ F~R.A B k.g AND NON.I~EFIJN'DAB L~ ANrD <br />BXI~I~.E I~ WOI~K IS NOT STARTED WTTH1N 180 DAYS OF ISSUANCE <br />OR · WORK IS SUSP.BVDED FOR 180 DAYS, <br /> <br />2A. cON~I~.CTOR IN$TAk. LATION ONLY <br /> <br />M~Add~ 3363 Silver,on Rd, NE <br /> <br />No. 24 - l C <br /> <br />Con[rac[oY$ go~rd Res, No, <br /> <br />Signature of Sul~rvi~[ng <br /> <br />S upervi~or'~ Lic~. ,~ No, 1282S <br /> <br /> FOR OWNER INSTALLATIONS <br /> <br />Job No, <br /> <br />Phone No, 363-2301 <br /> <br />PLAN REVIEW SECTION <br /> <br /> ~e will provide pla.n review service it' you complete Section <br /> 5B and submi, [we (2) seL~ of plans and $peci, ficadons <br /> ¢,is application. <br /> <br /> This OpLional plan review program docs no[ suspend the <br /> required submission of' lighting power calculations, plans, <br /> and specifications when required by [he Oregoa Structural <br /> Specially Code, Chap[er 53, <br /> <br />MC 15.34 11/91 <br /> <br />SITE #; ..... <br /> <br />Date: <br /> <br /> Issued by; ....... <br /> <br />4. FEE 8CH~DULI~ (Compl~t~ md ~mcr mud m Al b~low) <br /> <br /> 2~ amps or less $50,00 2 <br /> Re~ct ~ly $40,00 -- 2 <br /> <br /> Each l::~mp or irrigation circle $40.00 2 <br /> ~ach sign or ou[lin¢ lighti*~s __ $4000 -- 2 <br /> <br />~n~l. aheradon or ~x~mslon $40,00 2 <br />~ch additional [nsp~tl~ <br />~vc, ~r M~c~on $35.00 <br /> <br />Olher <br /> ( A¢ r~,~'r~d by Buil¢i~¢ <br /> <br /> FEES <br /> <br />A2, Add 5G surch~¢ <br /> <br />C, lnvcsHK~tionDee <br /> TOTALAMOUhWDUE * & 8 ~,,. <br />Recei~ No. ~ .............. <br /> <br /> <br />