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FOR OFFICE USE ONLY <br />Received by: 220 High Street NE <br /> Salem, Oregon 97301 <br />Date: <br /> Phone 588-5147 8:00 am - 4:30pm <br /> Code-A-Phone: 588-7904 <br /> FAX: 588-7948 <br /> ELECTRICAL PERMIT APPLICATION" I <br /> I <br /> P/ease complete al~ Sections, I through 5 <br /> <br />SITE #: <br /> <br />Date: MA/-{f5 '~ ,5' ;i/?\i <br />Issued by: ~llllnW? ''.~-,,, .,. <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />PERMITS ARE NON-TRANSFERABLE AND NON-REFUNDABLE AND <br />EXPIRE IF WORK IS NOT STARTED wrrHIN 180 DAYS OF ISSUANCE <br />OR IF WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />Con=c,o..c=eNo. <br />Contractors BoardReg. No. 9 0~0 [JobNo. <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br />Property Owner <br />Mailing Address I Phone <br />City/State/Zip <br /> <br />The installation is being made on property I own which is not intended for sale, <br />lease, or rent, <br /> <br />Owner's Signature <br /> <br />3. PLAN REVIEW SECTION <br /> <br />We 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 15-34 11/91 <br /> <br />4. FEE SCHEDULE (Complete and enter total in A1 below) <br /> <br /> Number of Inspe~tions per permit allowed q <br />A. <br /> Residential <br /> Per <br /> Unit <br /> / <br /> Service Included: Items Cost (each) Sum/ <br /> <br /> $85.00 4 <br /> 1000 sq. ft. or less <br /> Each additional 500 sq. ft. <br /> or portion the~of $15.00 <br /> Limited Energy $20.00 1 <br /> Each Manufd Home or Modular <br /> Dwelling Service or Feeder $40.00 -- 2 <br /> <br />Services or Feeders (Does not inlcude branch circuits, see section D) <br />Installation, Alterations or Relocation <br /> 200 amps or less $50.00 -- 2 <br /> 201 amps to 400 amps $50.00 . . 2 <br /> 401 amps to 600 amps $100.00 2 <br /> 601 amps to 1000 amps $130.00 2 <br /> Over 1000 amps or volts ,, , $;300.00 ~ 2 <br /> Reconnect only $40.00 2 <br /> <br />C. Temporary Services/Feeders <br />Installation, Alteration, or Relocation <br />200 amps or less $35.00 <br />201 amps to 400 amps $40.00 <br />401 amps to 600 amps $80.00 <br />Over 600 amps or 1000 volts <br />see "B" above <br /> <br />D. Branch Circuits <br /> New, Alteration, or Extension Per Panel <br /> <br /> a) The fee for branch circuits wi~ <br /> purchase of service or feeder fee <br /> <br /> Each branch circuit $2.00 <br /> <br /> b)The fee for branch circuts without <br /> purchase of service or feeder fee <br /> <br /> First branch circuit $35.00 <br /> Each additional branch circuit $2.00 <br /> <br />E. Miscellaneous (Service or Feeder Not Included) <br /> Each pump or irrigation circle / $40.00 <br /> Each sign or outline lighting $40.00 <br /> Signal circuit(s) or a limited energy <br /> panel, alteration or extansion $40.00 <br /> <br />E Each additional Inspection <br /> over the allowable in any of the <br /> above, per Inspection $35.00 <br /> <br />G. Minor Installation Labels <br /> Pack of 10 labels @ $5.00 each $50.00 <br /> (sold only to electrical contractors) <br /> <br />H. Other <br /> (As required by Building Official) <br /> <br />Al. Enter total of fees from Sec. #4 <br />A2. Add 5% surcharge (.05 x Al) <br /> <br /> Subtotal <br /> <br />B. Enter 25% of line Al for Plan Review <br /> (Sec. 3), if required <br />C. Investigation Fee (ffrequired) <br />D. Reinspection Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br /> <br />Receipt No. <br /> <br /> <br />