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FOR OFFICE USE ONLY <br />Received by: <br />Date: _ <br /> <br /> COMMON1TY DEVELOPMIglqT CENTEK <br /> 2ss cm.a~st. NE - Room I32 <br /> .Salem, O~lgon 97~01 <br /> <br /> P'none 588-5147 g:00 ~m - 4;30pm <br /> Codn-A-Phem: 588-7904 <br /> FAX: $gS-794S <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, I through ~, Issued by: <br /> <br />L LOCATION OF INSTALLATION <br /> <br />PEKM1T$ ARE NON.TRANSFERABLE AND NON-REFUNDABLE AND <br />EXPIRE I~ WORK I$ NOT STARTED WlTHIN 150 DAYS OF ISSUANCE <br />OR IF WORK I5 SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br />· PARt(IN ZL.E';.;:TR I C ~ <br />:20:',250 S PIOI,,,,AL.L.A <br /> <br /> L,57 "-'-4 9 5~} <br /> <br />2B, FOR OWNER INSTALLATIONS <br />Ptop~rty Owner <br />Mailing Address Phor~ <br />C~y]St sro/Zip <br /> <br />Thc inat allat~on is b~in$ mad~ on property I own wispa is not Lril~le{l for sale. <br /> <br />PLAN REVIEW SECTION <br /> <br />We will p~vida plan reviaw service if you complete Section <br />5B and submit two (2) s~ts of plans and specifications with <br />this application. <br /> <br />This optional plan review program does not SUSl:e~nd the <br />required submission of lighting powor calculations, plans, <br />and Specifications when required by the Oregon Structural <br />Specialty Code, Chapter 53. <br /> <br />MC 15-34 8/94 <br /> <br /> 5 0 1995 <br />cate: _BUILDING INSPECTION <br /> <br />4. PEE SCHEDULE (C~mpl~te ~nd enter toud ~ A1 ~low) <br /> Nnm~ of lnip~l~s p~ ~mlt allo~ ~ <br />A. <br /> g~en~ <br /> ~r <br /> Unit <br /> [ <br /> Se~e lnclud~ It.s Cost (ea~) S~1 <br /> 1~ aq.~ ~a $85.00 ~ 4 <br /> ~Mm ~of $~5.00 .,, <br /> <br />~+ Se~ Or F~ers ~s n~ ~l~d~ b~n~ Orcdts, see s~cd~ D) <br /> <br /> installation, Alterations or Relocation <br /> 200 ~unps or less ~ $,50,00 ~ 2 <br /> 201 ~ tO 4~ ~ps $~.00 ~ 2 <br /> <br />C. T~m~r~y <br /> <br /> ~ps~ss $35.00 ~ 2 <br /> 201 ~p$ to ~ ~ ~ $40.00 ~ 2 <br /> ~ ~ ~ps or I~ vol~ <br /> <br /> gumhase of s~ ~ f~et f~ <br /> <br /> Fret ~ch ~t ~ $35,00 <br /> <br />~, Ml~ellan~us ~rvj~ or ~r N~ Included) <br /> <br /> ~ch s~l or ~ne ~g $40.00 _, 2 <br /> <br /> ~r ~e ~owaVle ~ any ~ ~e <br /> <br /> ( ~ mqdred by Bu~d~ Offie~0 <br /> <br /> FEES <br />Al, Enter t~.al of fcc~ from Se~. #4 <br />A2. Add 5% surcharge (.05 x A 1) <br /> <br /> Sub~l <br />B. Bnmr ~7o ~ ~ne A1 for ~a~ Revicw <br /> <br />C. ~vmfigati~ F~ (ff required) <br />D. R~s~6~ F~ <br /> <br /> 'I~TAL AMOU~ DUE <br /> <br />$ <br />$ <br /> <br />Receipt No, <br /> <br /> <br />