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FOR OFFICE USE ONLY <br />Received by: <br />Date: <br /> <br />IELECTRICAL PERMIT APPLICATION <br />Please compl~to, all Section~, 1 through5 <br /> <br /> l, LOCATION OFINSTALLATION <br /> <br />St. <br /> <br />220 High Street NE itl ~ <br />Salem, Oregon 97301 FEB 0 4 }99,~ <br />Phone 588-5147 8:00 ~ - 4:9~ <br />FAX: 588-7~8 <br /> <br /> Issued by: <br /> <br />pEP.MI'rS ARE NON-TRANSFERABLE AND NON.REFUNDABLE AJXrD <br />EXHRF, IF WORK 1S NOT STARTED WiTHEN lEO DAYS OF ISSUANCE <br />OR IF WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2Bi FOR OWNER iNSTALLATIONS <br /> <br />property Owner <br /> <br />City~tate/Zip <br /> <br />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 />SITE #: ~J0,~ t"ruP~[~it"N°' <br />Date: BUILOiN6 INSPECTION <br /> <br />4, PEE SCHEDUEE (Complete and enter total ~) A 1 below) <br /> Unit <br /> <br /> 200 amps or less $50.00 <br /> <br /> III stallatlon, Alteration, or Relocation <br /> 200 ~pa or ~ss <br /> <br />a) ~ f~ for ~nch drcMta ~ <br /> <br /> Each bm~ ~uit <br /> <br /> ( AX mq~red by BuZlding Offic~0 <br /> <br />$35.00 2 <br />$80,00 __2 <br /> <br /> $2,00 <br /> <br />$40.00 <br />$40.00 <br /> <br />$35,00 <br /> <br />$50.00 <br /> <br />5. FEES <br /> Al. Enter total Of t~es from Sec. #4 <br /> A2. Add 5% suteharg~ (,05 x Al) <br /> <br /> Subtotal <br /> <br /> B. Enter 25% of }~ae A1 for Plan Review <br /> (Sec. 3), if required <br /> C, Inwstigatkmvee~. (ff ~eqnimd) <br /> DI Rcinspectlon Fcc <br /> <br /> TO'f AL AMOUNT DUE <br /> <br />$ <br />$ <br /> <br />MC 15-34 ]]/91 <br /> <br /> <br />