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FOR OFFICE USE ONLY <br />I Received by: <br />If)ate: <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, 1 through <br /> <br />Salem, Oregon 97301 <br />PhoneS88-5147 8:00~mCode,A,Phone: 588.7904'4:3OPm dl~l~ ~ 2 ~,~mLt No. <br /> PAX: ~a8-7948 SITE #: <br /> Date: i~-..~-~ION C0UA/T¥ <br /> "u,' uING INSP[C~JON <br /> Issued by: <br /> <br />JobAddress 385 I 0TH PL <br /> <br />City AUMSVILLE I Crc. S~, <br /> <br />EXPIJ~5 I? wORK TS NOT STkRTED WFI~ 180 DAYS <br /> <br />2A. £:ONTRACTOR INSq'ALLATION ONLY <br /> <br /> ']"Phone <br />l"lectncalComractor Code Electric 581-8684 <br />M,dieg^dd,es* 2717 22nd St. SE - Salem <br />Pro.ny Owner DOYLE SMITH ~Ph~¢ <br /> <br />Contractor% Board Res, No, 19 866 I Job <br />$1snamm or Supervising EIo~rician'r~¥~0.O,~L~.~ ~ <br /> <br />2B, FOR OWNER INSTALLATIONS <br /> <br />P ropZ¢.¥ Owner <br />Mailing Address I Phone <br />City/gtatef~ip <br /> <br />The installation i* bcing mede on pro. fly [ own wh/ch i~ not intended for sale, <br /> <br />3. PLAN REVIEW SECTION <br /> <br />We will provide plan review so.ice if you complete Sex:don <br />5B and submit two (2) sets of plans and specLfica[io~s with <br />this application, <br /> <br />This optional plan review program does not suspend the <br />required submission of lighdng 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 />a, FEI~; SCHEDULE (Complete and enter total m .,\ l below) <br /> <br /> Number of Inspections per permit allowed <br /> <br />^, <br /> Reside~tlal <br /> per <br /> Unit <br /> Service Included: Items Cost (each) Sum <br /> <br />1000 sq, fl. or <br />Each ad~;ior,a1500 ~q. ft. <br /> <br />Limited EnceSy <br />Each Manufd Home or M~ular <br /> Dwe~ag $e~ or Feed6~ <br /> <br />$8500 <br /> <br />$15.00 <br />$20.00 I <br /> <br />$40.00 __2 <br /> <br />$50.00 __ 2 <br />$60.00 __. ~ <br />$1OO,OO 2 <br />$130,00 .... 2 <br />$300.00 __ 2 <br />$40.00 __ 2 <br /> <br />$3500 __ 2 <br />$40.00 __ 2 <br />$8000 __ 2 <br /> <br />$200 <br /> <br />$35 O0 <br /> $200 <br /> <br />$40.00 __ 2 <br />$4000 ___ 2 <br /> <br />$40.00 ..... 2 <br /> <br />$3500 <br /> <br />$50,00 .... <br /> <br />5. FEES <br /> Al. Enter total of fees from Sec. #4 <br /> AS. Add 5% surcharge (.05 x Al ) <br /> <br /> Subtotal <br /> <br /> B, Enter 25%of lineAl for Plan Review <br /> (Sec. 3), if required <br /> C, lnvc~tigatio~Fe¢ ([f required) <br /> D~ ReimFecdon Fee ($25.00) <br /> <br /> TOTAL AMOUNq' DUE <br /> <br /> Receil~t No. <br /> <br />$ 37.00 <br /> <br />$--I. 8 5.,~ <br /> <br /> <br />