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FOR OFFICE USE ONLY <br />Received by: <br />Date: <br /> <br />ELECTRICAL PERMIT APPLICATION <br />P/ease complete all Sections, I through 5 <br /> <br />1. LOCATION OF INSTALi. ATION <br /> <br />PF22dlTS ARB NON-TRANSFERABLB AND NON.REFUNDABLE AND <br />EXPIRE 19 WORK IS NOT STARTED WITIIII~ l~O DAYS OF ISSUANCE <br />OR IF WORK IS SUSPENDED FOR 180 DAYS, <br /> <br />2A, CONTRACrOR INSTALLATION (iNLY <br /> <br />Supe~sor s ~mnse NOI ~v ~ ~II~- /~h°ne NO~.~)A~: <br /> <br />2Sl FOR OWNER INffI'ALLATIONS <br /> <br />['toper~y Owner <br />Mailing Address I Phone <br /> I <br /> <br />City/St ate[Zip <br /> <br />Thc instalhlion is being made on property I own which is nc~ ~ntended for sale, <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 pmgrmn does not suspend the <br />required submission of lighting power ca/culalions, plans, <br />and specifications when required by the Oregon Structmal <br />Specially Code, Chapter 53. <br /> <br />MC 15.34 11191 <br /> <br />4. FEE SCHEDULE (Complete and amcr total/~ A 1 below) <br /> <br /> Number of Inspoctions per permit allowed <br /> <br />A- <br /> R~dd~al <br /> Fee <br /> Unit <br /> Se~lce Included: Items Cost (c~h) ~um/ <br /> <br /> 10~ ~q. fl, ~ less $g5,00 4 <br /> Each a~fi~l 5~ sq. ft. <br /> or ~ffim tbemof $15l 00 <br /> Lmited Enemy $20.00 ~ 1 <br /> Each Manufd Home ~r M~ular <br /> <br /> lns~llatlon, AIterations or Reliction 1 <br /> ~ amp~ ~ le~s, [ $50.00~ 2 <br /> <br /> 601 amps to 1000 amps <br /> <br />C, Temporary Services/Feeders <br /> <br /> 201 amps to 400 amps <br /> 401 amps to 600 amps <br /> Over 600 amps or 10~0 volts <br /> <br />D, Branch Circult~ <br /> <br /> a) '/lin fee for branch tire.ts with <br /> <br /> b) The fee for branch circuits wlthout <br /> parchase of ser~i~~ 07 [t~dcr fee <br /> <br /> Fire bntnch circuit <br /> <br />E, Mi~ella~eous (Service nr Feeder Nut Included) <br /> Each sign or oathae lighting , <br /> S~gnal ci~uil(s) or a lJ.nfitcd ~n~rgy <br /> <br />E Each additional lnsp~tlon <br /> over the allowable in any of the <br /> abOve, per ~llspeet~on <br /> <br />G1 Minor Installation Labels <br /> Pack of 10 labels @ ~.00 each <br /> <br /> ( A~ reqtdred by Building Official) <br /> <br />$100,00 2 <br />$130.00 -- 2 <br />$~00.00 __ 2 <br />$40.00 2 <br /> <br />$35100 ...... 2 <br />$40.00 ~2 <br />$80.00 __2 <br /> <br />$2,00 <br /> <br />$35.00 <br /> $2,00 <br /> <br />$4000 ~ <br />$40.00 --2 <br /> <br />$dO.O0 --2 <br /> <br />$85.00 <br /> <br />Sso.oo <br /> <br />5. FEES <br /> All F~r total of lhes from Sec. #4 <br /> A2. Add 5% surcharge (,0~ x Al) <br /> <br /> S~btotal <br /> <br /> B. Enter 2~% o[ltheA1 for Plan Review <br /> (Sec, 3), if required <br /> C. Investigalion Fee (it' required) <br /> D, Reinspe¢6on Fee ($25,00) <br /> <br /> 'lOlrAL AMOUNT DUE <br /> <br /> R~.ceipt No, <br /> <br />$ <br />$. <br /> <br /> <br />