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ELECTRICAL PERMIT APPLICATION I Datel~A~~ ..... <br /> Ul~ UUUNI¥ <br />Please complete all Sections, I through 5 . [sl~lG ~I~!Sp£~T!O:; <br /> <br />L LOCATION OFINSTALLATION <br /> <br />Iob Address i<:~O ~ lq ¢'~ 1T-r- ~xl~---. ........... <br /> <br />PE~S ARE NON-~A~S~RABLE AND NON-~AB~ ~ <br />EXP~E IF WORK IS NOT STARTED W~ 180 DAYS OF ISSU~CE <br />OR IF WORK IS SUSP~DED FOR 180 DAY3. <br /> <br />2A, CONTRACTOR INSTALLATION ONLY <br /> <br />Mt(fling Address <br />Property Owncr [ Phone <br />CoattactoFs License No, <br />Contraeto¢$ Board Reg, No. I Job No. <br />$~nam~ of Su~ia~g El~tfician <br />Su~JsoF$ ~sc No. ] P~nc No. <br />FOR OWNER INSTAL~TION$ <br /> <br /> Propelty <br /> Owner <br /> <br />City/State/Zip EL~6 O~--- .... q'~ q O ~ <br /> <br />Owncr'~ Signature . ,, <br />3, PLAN R~VI~W S~CTION <br /> <br />Wc will provide plan review service if you complete Section <br />5B and submit two (2) sets 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 required by the Oregon Structural <br />Specialty Code, Chapter 53, <br /> <br />MC 15-341]/9] <br /> <br />4. FEE SCHEDULE (Complete and enter total jB A I below) <br /> <br /> Number of Inspections per permit allowed ~] <br /> <br />A. <br /> Residential <br /> Per <br /> Unit <br /> ! <br /> Service Included: Items Cost (each) Sum/ <br /> <br /> 1000 sq. a. or less $83.00 4 <br /> Each addltioaa1500 sq, IL <br /> or portion the~of $15.00 <br /> Limited Energy $20,00 __ 1 <br /> <br />tisch Manufd Home or Modular <br /> Dwelling Service or Feeder <br /> <br />B. <br /> <br />$40.00 -- 8 <br /> <br />Ins~llanon, Alterations or RelOcatinn ~ <br />200 amps or <br />201 amps ro 400 amps <br />401 amps to 600 amps <br />601 amipa~ to 1000 amp~ <br />Over 1000 amps or volts <br />Reconnect only <br /> <br />200 amps or less <br />201 amps to 400 amps <br />40I araps to 600 amps <br />Over 600 amps or 1000 voItq <br /> <br />D, Branch Circuits <br /> <br /> a) The fee for branch circuits with <br /> j~prchase of se~ce or <br /> <br /> 'Each bm~ ~uit ........ <br /> <br /> b) ~e f~ for branch ~reut$ w~t~9~ <br /> ~rchaac of ~e~ice ~ fe¢~er fcc <br /> <br /> ~ch ~difional b~ch cimait <br /> <br />E. Mi~ellan~a (Servl~ or Feeder Not Included) <br /> Each pump ~ i~gafim drde <br /> Each slgnor ~ne ~gh~g <br /> Signal ~mui[(~) ~ a h~d enemy <br /> <br />F. Each additional ln~p<tlon <br /> ~¢r ~e a~owable ~ any of ~e <br /> a~ve, per ~specfi~ <br /> <br />G. Minor Insmllatlon Labels <br /> Pack of t0 la.la ~ $5.00 <br /> (~oM oMy to electrical contmctors) <br /> <br />H, Oth~ <br /> (As ~quired by Baild~g Offlc&O <br /> <br />50.00 <br />foo.o0 <br />$100,00 __ 2 <br />$130.00 __ 2 <br />$300.00 __2 <br />$40.00 __2 <br /> <br />$35.00 --2 <br />$40,00 --2 <br />$80.00 __2 <br /> <br />$2.00 <br /> <br />$35.00 <br /> $2,00 <br /> <br />$40.00 2 <br />$40.00 --2 <br /> <br />$40,00 __2 <br /> <br />$35.00 <br /> <br />$30.00 <br /> <br />5. FEES <br /> A 1, Enter total of fees from Sec. #4 <br /> A2, Add 5% surcharge (-05 X Al) <br /> <br /> Subtotal <br /> <br /> B, Enter 25% of 1/ne A 1 for Plan Review <br /> (Sec, 3!, if requinxl <br /> C, In,~estigationF¢¢ (if refit)ired) <br /> <br /> 'rOVIISL AM, gUNT DUE <br /> <br />$ <br /> <br /> <br />