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FOR OFF! g USE ONLY <br />Received by: <br />Date: <br /> <br />IELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, 1 through <br /> <br />~IARION COUNYY BUILDING INSPECTION <br /> 220 High <br /> Salem, Oregon 97301 <br /> <br /> Phone ~88~147 <br /> <br />SITE #: <br />Dale: ............ <br /> <br />Issued by: <br /> <br />Permk No, <br /> <br />L LOCATION OFINSTALLATION <br /> <br /> , <br /> <br />P~ ~ ~ NO~-~S~BL~ <br />~ · WORK IS NOT $T~TSD W~ <br />OR · WORK ~ ~USP~DED FOR I a0 DAYS. <br /> <br />lA. CONTRACTOR INSTALLATION ONLY <br /> <br />Owners ~igpato~ , , <br /> PLAN REVIEW SECFION <br /> <br /> Wc will pmvid~ plan rcv~ow service if you complete $~50n <br /> 5B and submit two (2) se~ of plans and ~p~tcadons wi~ <br /> this application. <br /> <br />Thii optional plan raWew program do~s not suspend thc <br />required submission of lighdng ~wcr calculations, plans, <br />and s~dicafions when r~uir~ by ~c Oregon $~ct~al <br />$~ci~ty C~c, Chapter 53, <br /> <br />4, FEE SCHEDULE (Completo ~md ~tor total in Al I~low) <br /> <br /> Pvr <br /> Service included: hems C~ <br /> <br />1~ sq, ~ ~ less ~ $~.00 <br /> or~m~ ~e~o~ $15 <br />~m~d Eriee~y ~ $20,00 <br /> <br /> Ow~ni Sc~ ~ F~dcr $40,00 <br /> <br /> l~s~llafl~ Allcratlons or Rcl~tlo~ <br /> 2~ am~ ~ less I $50 OO <br /> <br /> ~l amps ~ ~ amp~ ~ $100.~ <br /> ~1 Im~s ~ 1~ amps $130. <br /> <br /> 401 ~p~ to ~ amps $~,00 <br /> ~er ~ ~p~ or 1~ vohs <br /> <br />D. Br~n~ Clrcul~ <br /> N~w, Alteration, or gxi~nslon ~r Panel <br /> <br /> a) ~e f~ for bran~ <br /> <br /> ~h bt~h ~uit $2,~ <br /> b) ~= f~ f~ blanch d~uts ~ <br /> <br /> P~t branch ~ $35,00 <br /> ~h addi~ b~nch circuit <br /> <br />g. M~cllan~us (~etvlce or Feeder Not <br /> ~ach ~mp or i~g~ ~clc ~ <br /> Ba~ ~jgn Bt ~nc lighting <br /> Signal cir~i~(s) or a ~ml~d <br /> ~ncl. at,ratiOn or extrusion <br /> <br />R ~ch additional I~p~tlon <br /> <br /> Pack ~ lO h~ls ~ S5.~ ea~ <br /> (~otd ~ to g=¢tri~al <br /> <br />~. Other <br /> <br />$. FEES "' <br /> Al. Enter ~aI of f~e~ from Sec. ~4 <br /> Al, Add 5~ surcharge (.05 x Al) <br /> <br /> Sobtotal <br /> B, En~r ~% ~f dna A1 for Plan Rcvic~ <br /> <br /> ~ ~va{tigtti~ Fcc {~ mqulmd) <br /> D. R~6~ Faa <br /> <br /> ~TAL AMOUNT <br /> <br /> <br />