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FOR OFFICE USEONLY I <br />Reeeiv~by:,~ <br />Date: <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete afl Sections, I through 5 <br /> <br />Phone 588-5147 8:00 nn . 4:30pm J4N <br />~e-A-~c: 588-7~ Permit No, <br />~: 5ss-7~s SiTE ~: . ....... <br /> <br /> Date: BUILDI~ <br /> <br /> Issued by: <br /> <br />1. LO~ATION OF INSTALLATION <br /> <br />~ I~ WO~ ~ NOT ~TART~ ~ 1~0 DAYS OF ISSU~CE ' <br />OR ~ WO~ I~ S USP~ED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />Mailing Address Phone <br />City~[ate/Zdp <br /> <br />The installation is l~ing made on property I own wlaiOl is n~ intended fol' sale, <br /> <br />Owner's S~gnamre ...... <br /> <br />3, PLAN REVIEW SFJ2TION <br /> <br /> We will provide plan review service if you complete Section <br /> 5B and submit two (2) se~s of plans 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 requked by the Oregon Structural <br /> Specialty Code, Chapter 53, <br /> <br />MC 15.34 11/9.1 <br /> <br />4, FEE SCH]~DULE (Coraplete and ~ntcr toter ~1 Al below) <br /> <br /> Numl~r ~ Inspections p~- permit allowed <br /> <br />A. <br /> Rezldent~a[ <br /> Per <br /> Unit <br /> <br /> 10~ si, fh ~ less $85.00 <br /> E~h ad~fio~ 5~ s9, ft. <br /> <br />~i~d ~nc~y $20,00 <br /> <br />Bach Ma~ufd Home or Modular <br /> Dwelllns Sct~4_~ or Feeder <br /> <br /> $40.00 Z <br />$~xvto~s or F~eder$ (Does not/nlcud~ blanch circuits, see se~on D) <br /> <br /> Ove~ 1000 m~ps of volts <br /> P~c~me~t c~dy <br /> <br /> ~ravy Servlc~d~ <br /> <br /> ~ ~p~ or I0~ vows <br /> <br /> a) ~e f~ for b~ch dm~ <br /> <br />~ f~ f~ bran~ ~muts wi~t ~ha$~ of aewice or feeder fee <br /> <br /> Eaeh addifi~ bm~h ck~it <br /> <br /> Each *ign or ouffina l~h~g <br /> <br /> ~. per ~s~fion <br /> <br /> , ( As mq~md by ~uilding Offle~l) <br /> <br /> FEES <br /> Al. ~mr total of fees fm Sec. <br /> A2. Add 5% sumha~e 605 x Al) <br /> <br /> Submml <br /> <br /> C. ~ve~a~nFee ~ ~uimd) <br /> D- R~sp~fi~ Fee ($~.00) <br /> <br /> ~50,00 <br /> 60,00 <br />$100.00 <br />$130,00 <br />$300,00 <br />$40.00 <br /> <br />$35.00 ~2 <br />$40.00 _,,_ 2 <br />$80.00 2 <br /> <br /> 35_c° <br /> <br /> ~40,00 -- 2 <br /> 40,00 __ 2 <br /> <br /> $40.00 -- 2 <br /> <br />$35.00 <br /> <br />SSO,O0 <br /> <br />~5 oo <br /> <br />$ <br />$ _ <br />$ <br /> <br />Re~i¢ No, <br /> <br /> <br />