Laserfiche WebLink
FOR OFFICE USE ONLY <br />Received by: <br />Date: <br /> <br />ELECTRICAL PERMIT APPLICATION <br />P/ease complete all Sections, I through 5 <br /> <br />Code. A.Phone: 555-7904 <br /> FAX: 555-7948 ,q <br /> <br /> Permit <br />SITE ¢~V~ftRiON <br /> ~,~or cl~ I tUN <br />issued by: <br /> <br />LOCATION OF INSTALLATION <br /> <br />I>EI~MITS ARE NON-TRANSFISRABLE AND NON-REFUNDABLE AND <br />EX1/RE It' WORK tS NOT STARTED WFFIIIN 1 $0 DAYS OF ISSUANCE <br />Ol~. IF WORK tS SUSPENI)I~I) FOR 180 DAYS. <br /> <br />2A. UON'I'RA~rOR INFF£ALLKflON ONLY <br /> <br />ElectricalCOntractor q t~t'fl ~ ~ <br /> <br /> I ~on . <br /> <br />2II. FOR OWNER INSTALLATIONS <br /> <br />Mailing Address <br /> <br />City/State/Zip <br /> <br />1'he inatallafico ia being made on property I own which Es not hatended for sale. <br /> <br />Owncr's Signature <br /> <br />3. I'I.A N REVIEW SECTION <br /> <br />We will provide plm~ 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 iX>wet calculations, plans, <br />and specifications when required by the Oregon Structural <br />Speci;dty Code, Chapter 53, <br /> <br />MC 15-34 11/91 <br /> <br />4, FEE SCHEDULE (Complete and enmt tolal in A 1 below) <br /> <br />A. Residential Per Unit <br /> Service Included: <br /> <br />I~000 $~. ft. or less <br />Each aaditional 500 sq. ft. <br /> or portico thereof <br />Limited Energy <br /> <br />$85.00 __ 4 <br /> <br />$15.00 <br />$20.00 __. 1 <br /> <br />15ach Manuf'd Home or Modular <br />Dwelfing Service or Feeder $40.00 <br /> <br />B. Services or Feeders (Does not inlcudc branch circuits, see seedon D) <br /> <br /> 200 amps or less ~ _ <br /> <br />C, Temporary Services/Feeders <br /> <br /> 200 amps or less <br /> 201 amps to 400 amps <br /> 401 amps to 600 amps <br /> <br />D, Branch Circnits <br /> <br /> a) The fee for branch clrcu~ts with <br /> purchase of servlee or feeder fee <br /> Each branch circuit ~-q} <br /> b) 'i3e fee for branch cleco[s ~ <br /> <br /> l;irut branch circuit <br /> Each additional branch circuit <br /> <br />E. Miscellaneous (Service or Feeder Nnt Included) <br /> <br /> ~ach sign or o~tllne lighting <br /> Signal circuit(s) or a ~r~dted eoergy <br /> <br />E Each addRional Inspection <br /> OVer the allowable in any of the <br /> above, per Inspection <br /> <br />G, Minor Installation Labels <br /> Pack of 10 labels @ $5.00 each <br /> (sold only ~o electrical con~ractor~9 <br /> <br /> (A~ r~quired by/~ uildi~g Officla/) <br /> <br /> 50,00 <br /> ~8o,oo ~ <br />$100.00 __ 2 <br />$130.00 __ 2 <br />$300,00 -- 2 <br />$40.00 __ 2 <br /> <br />$35.00 <br />$40.00 <br />$80,00 <br /> <br />$2.00 ':4~ .~ <br /> <br />$35,00 <br /> $2.00 <br /> <br />$40.00 __2 <br />$40.00 ....... 2 <br /> <br />Sd0.00 __2 <br /> <br />$35,00 <br /> <br />$50.00 <br /> <br />5. FEES <br /> $ ...2.~ <br /> Al, [Sntef total of fees from S~'~, tl4 <br /> a2. AddS%~urchgrge(OSxAl) ~L[ <br /> <br /> g. Enter 25~ of llne A1 for Plan Revlew ~O- <br /> (S~. 3), if requlr~ <br /> 6. In~e~ti[atlco Fee (if mqulmd) <br /> D, Reinsped~J~ Fee (S2~,00) $ <br /> TOTAL AMOUNT DUE I~.~ <br /> <br /> <br />