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"FOR OFFICE USE ONLY <br /> Received by: -- <br /> Date: <br /> <br />ELECTRICAL PERMIT A,PPLiCATION <br />Please complete all Sections, I through 5 <br /> <br />L LOCATION OFINSTALLATION <br /> <br />Sob Address <br /> <br />Description <br /> <br /> Salem, O~son 97301 "- 0 2 ]994 <br />~c ~88-5147 8:~ ~ - <br /> ~e-A-~: 588-7~4 t ~, <br /> F~: 588-7~8 SI~0N uuu,~, ~ P~rmit No. <br /> g ING iNSPECTION <br /> <br />st. <br /> <br />pERMiTS ARE NON .'IRANSFERABLA AND NON-R]~F~NDABLE AND <br />~XF/RE IF WORK IS NOT STARTED W~THIN 180 DAYS OF ISSUANCE <br />OR IF WORK IS SUSPENDED FOR 180 DAYS, <br /> <br />2A. CONTRACTOR INSTALLATION ONLy <br /> <br /> PARK:iN ELECTRIC, INC. <br /> 20250 S MOLALLA AVENUE <br /> OREGON C'.ITY~ OR 97045 <br /> <br />SuFo~i~or s U~c No. [ Phone No. <br /> I <br /> <br />2n..yoa OW~ER..?STAL:ATIOSS <br /> <br />Mailing Address Phone <br /> <br />City/State/Zip <br /> <br />Thc installation is being made on property ~[ own whinh is <br /> <br />Own*~'s Sisnatum .... <br /> <br />3. PLAN REVIEW SECTION <br /> <br /> We will provide plan review service if you complete Section <br /> 5R and submit two (2) sots 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 /> Issued by: <br /> <br />4. FEE SCIIigDULg (Complct* &*10 enter total in Al below) <br /> <br /> Number of Inspections per pemnlt allowed -~ <br />A. <br /> R~klenttal <br /> P~r <br /> Unit <br /> Service Includedt I~s Cost (c~h) S~/ <br /> <br /> I~ sq, fi, ~ lcss $85,00 4 <br /> E~h a~ 5~ sq. fi, <br /> ~ ~ffi~ ~of $ ~ fi.00 <br /> <br />E~M~H~corM~t ~ '$40,00 ~' ~ <br />Dw~ng Se~ ~ Fea~ , <br /> <br />~. Ser~s or Fee~rs (Does not ~l~ ~nch city,ts, soo scc~ D) <br /> <br /> Installation, Alterations or Relocation <br /> 200 am[~4 cot ~sa <br /> 201 amps to 400 ~'npa <br /> 401 amp~ to 6IX) amps $100,00 <br /> 601 amps lo 1000 amps $'lg0.00 <br /> Over 1000 ~,mps Or volt~ $300.00 <br /> ~.conncot ~lly $40.00 <br /> <br />C, T~mporary Servlge~s/F~'d~r~ <br /> <br /> 200 ~,mps or l~ss $35,00 <br /> 201 amps to 400 amps $40,00 <br /> 401 ~mps to 600 amps $80.00 <br /> Ovc.r,~,6~0. amps or 1000 volts <br /> se~ B abo~e <br /> <br />D, Branch Circuits <br /> <br /> a) The fee for Branch circffitq with <br /> purchase of sefvi~ or feeaer,fee <br /> <br /> Each bm& circuit -- $2,00 <br /> b) The fee for brench clrolts wlth~ct <br /> <br /> First branch circuit $a5.00 <br /> ga~h additional branch ebcult $2.00 <br /> <br />E. Miscellaneous (s,rvtee or Feeder No~ <br />Each Cutup o~ irdgntion cimta $40.00 <br />Each sign or ouffiua 1;string $40.00 <br />Signal cimu~t(s) or a limlted ~ncrgy <br />panel, alt~ratinn or extension $40,00 <br /> <br />F. E~ch additional Inspection <br /> OVer the allowable in any of tho <br /> nix>w, For InSl~tion <br /> <br />G. Mtaor Installation Labels <br /> Pack <ff 10 labda @ $$.00 each ..... <br /> (,raid o~ly to el, ctrlcal aardractor$) <br /> <br />}i. Ogbgla <br /> (As required by Building Offi~iaO <br /> <br />5. FEES <br /> A I. Shier tc~al of fees from See, #4 ~ <br /> A2. A(I(I 5% ~ureha~ge (.05 x Al) <br /> <br /> Subtotal $ <br /> <br /> B. Enter 25% of ~ A I foe Plan Re'~ew <br /> (Sec, 3), if reqttiz~l <br /> C. Investigation Fee (if requlmd) $ <br /> D. Rclmpection Fc~ ($25,0~) $ <br /> <br /> TOTAL AMOUNT DUI~ $ <br /> <br />l;~ceipt No. <br /> <br /> <br />