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' by- <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, 1 through 5 <br /> <br />Chy [ Crov~ St, <br /> <br />l~¢ript~on <br /> <br />PEI~4T~ ARE NON-TRANSFERaBLE ,aND NON-ILEFU~DA~ LE A~D <br />EX[IRE ~ WORK IS NOT STARTleD WITH]lq 180 DAYS OF ISSUANCE <br />OR Il2 WORK IS SUSPENDED FOR 130 DAYS, <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />~l¢~tical C~mtracto '~ ~ <br /> <br />Mailing Address <br /> <br /> SCHEDULE (Complete a~d e~ter tot~l in Al ~low) <br />ISPECTION $.~ ~ ln*~tlons p~ ~lt allow~ <br /> R~ldentlal Per Unit <br /> <br /> Enemy $~.00 ~ 1 <br /> <br /> Installation, Alterations or Relocation <br /> 200 amps or less $,c'~),00 <br /> <br /> 401 amps to 600 amps $100,00 <br /> 601 amt:v$ to 1000 ampa $130,00 <br /> <br /> R~onneet o~Iy $40.OO <br /> <br /> 200 amps or less $35.00 <br /> 201 amps ~o 400 amps $40.00 <br /> 40I amps to 600 amps $80.OO <br /> <br />D, Branch CircoRs <br /> <br />G & J ELECTRIC, INC. <br />236~ HYACINTH N.E, 364-5332 <br />SALEM, OR 97303 <br /> <br /> , <br /> <br /> 5204 <br /> 06-8 <br /> <br />,~%LLARS <br /> <br />3, PLAN REVIF. W SECTION <br /> <br />We will provide plan review service if you complete Section <br />51t and submit two (2) sets of plans and specifications with <br />this application. <br /> <br />This optional plan review program does not suspend the <br />required submission of lighting power calculations, plates, <br />and specifications when required by the Oregon Structural <br />Specialty Code, Chapter 53, <br /> <br />MC 15-34 11/91 <br /> <br />5. FEES <br /> <br />Al. Enter tc~al of fees from S~c, ~4 <br />A2, Add 5% surcharge (.05 X Al) <br /> <br /> Subtotal <br /> <br />B. En~r ~% of ~e A1 for Plan Review <br /> (S<, 3). if ~Mr~ <br />C. ~vestigatiOn Fee (~ ~qu~d) <br />D, Re~fi~ Fee ($~,~) <br /> <br /> TOTAL ~OUNT DUE <br /> <br />Rece[~ Nm <br /> <br /> <br />