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FOR OFFIC. q..EyS.,~pNLY <br />Rece!ved by:~ <br /> <br /> 220 Higtl StrcetJ,IE <br /> Salem, Oregon 97301 <br /> <br />Phonz 588-5147 8:~ <br /> ~e-A-~: 588-7~4 <br /> FAX: 588-7~8 <br /> <br />ELECTRICAL PERMIT APPLICATION <br />P/ease complete all Sect/ons, I through 5 <br /> <br /> Permit No, <br /> <br />~aI~.LDINO INSP[CTION <br />Issued by: <br /> <br />P EI~v[I'I'S ARE NON-'IlqANSFt~RABLE AND NON-REFUNDABLE AND <br />EXPB:[I~ IF WORK IS NOT STARTED WrTI-IIN 180 DAYS OF ISSUANCE <br />OR IF WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A, CONTRACTOR INSTALLATION ONLY <br />Electrical Ccratractor <br /> <br />Commetofs Liceas¢ No. <br /> <br />Contractor's Roard Rog, No. <br /> <br />IJobNo. <br /> <br />Signature of Suparvising Electrician <br /> <br />The installation is being made on property I own wi~eh is nc.,~ intended for sale, <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 />4. FEE SCHEDULE (Complet* ~nd enter total in A1 below) <br /> Number of Inspections per permit snowed ~ <br />A. <br /> Residential <br /> Per <br /> Unit <br /> Service Dlcluded: Items Coat (each) Sum <br /> <br /> 1000 s~, f~, or less $88,00 d <br /> Each ad~ao~a1500 sq. ft. <br /> or porfic~ thereof $15,00 <br /> Limited Eneegy $20.00 -- 1 <br /> <br /> Dwelling Feeder .--~ $40.00 __~ <br /> <br />ti. $ervlce~ or Feeders (Does not inleude branch circuits, ~ee section D) <br /> <br /> Installation, AlteratiOnS Or Retm2ation <br /> 200 amp~ or less $50.00 <br /> 201 amps to 400 amps $$0.00 <br /> 401 amps to 600 amps $100.00 <br /> (R)I amlxq to 1000 amps $1~0.00 <br /> Owr I000 ~nps or volts $S00.00 <br /> Reconnect only $40.00 <br /> <br />C. Temporary Servlee$/Fe~der~ <br />Ins~llxtinn, Alterxtinn~ or <br />200 amps or less $35.00 <br />201 amps m 400 amps $40 <br />401 amps to 600 amps $80,00 <br />Over 600 amps or I000 volts <br /> <br />D, Branch Circuits <br /> New, Alteration, or Extension Per Panel <br /> <br /> a) Thc fcc for branch clmults with <br /> purchase of service or feeder fee <br /> <br /> Each branch circuit $2,00 <br /> <br /> b)The fee for branch c~rcuts without <br /> lmrchase of servi ,c~ or fe/eder <br /> <br /> First branch circuit $S5.00 <br /> Each eddMonal branch ¢imuit $2,00 <br /> <br />IS, Miscellaneous (Service or Feeder Not Included) <br /> Each tromp or irrigation circle $40.00 <br /> Each sign or oudine lighting __ $40.00 <br /> Signal circuit(s) or a ~mJt. ed <br /> panel, alteration or ext<sion $40.00 <br /> <br />F. Each additional Inspection <br />over the allowable in any of the <br />above, per Inspection $S5.00 <br /> <br />G. Minor Installation Labels <br /> Pack of 10 labels @ $5,00 each $S0.00 <br /> (~,old only to electrical cordractam) <br /> ( As requlred by Buildlhg'Officfal)" --- ~ <br /> <br />Al, F. nter to, al of fees from Sec, g4 <br />A2, Add 5% surcharge ( 05 x Al) <br /> Subtotal $ ~0 <br />g. Enter 25% of line A1 for Plan Review <br />(S~c, 3), if required $ <br />C. Investigation Fee (ffrequired) $ <br /> <br /> - 3,]'OT~,L ,A~J~OUNT DUE $ ~--"~[~. r~t.~ <br /> <br />MC15.34 1ll91 , <br /> <br /> <br />