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FOR OFFICE USE ONLY <br /> Receive~d by: <br />ID~ate: ~ <br /> <br />ELECTRICAL PERMIT APPLICATION' <br /> i <br />P/ease complete all Sections, I through 5 <br /> <br />1. LOC~TION OF INSTALLATION <br /> <br />Job Address 71o0 <br /> <br />Dimctions <br /> <br />PERMITS ARJg NON-TRANSFERABLE AND NON-REFUNDABLE AND <br />EXPIRE IF WORK tS NOT S1ARTED WTTI-IIN 180 DAYS OF LqSUANCE <br />OR IF WORK IS SUSPENDED FOR 180 DAYS, <br /> <br />'Phone <br /> <br />2B, FOR OWNER INSTALLATIONS <br /> <br />Property Owner <br /> <br />Mailing Address <br /> <br />~City~tate/Zip <br /> <br />The imt alladon is be, bag maOe on propex~y I own wb~c~ is n~x in~ndcd for sale. <br /> <br />3, PLAN REVIEW SECTION <br /> <br /> We will provide plan review sepAce if yOB 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 />rcquirod submission of lighting power calculations, plans, <br />and specifications when required by the Oregon Structural <br />Specitdty Code, Chapter 53. <br /> <br /> 220 High Slreet NE <br /> Salem, Oregon 97301 <br /> <br />Phone 588-5147 8:00 am - 4;3Opsn <br />Code-A-l'aone: 588-7904 <br /> FAX: 588-7948 <br /> <br />MC15-34 11/91 <br /> <br /> ~RION COUNT~ermlt us. <br />SITF~Ji~uJiqG t~$?~CTION <br />Date: <br /> <br /> Issued by: <br /> <br />4. FEi.; SCHEDULE (Complete and enter total in A1 below) <br /> Number of Inspections per permit allow~ <br />A. R~identlal ~r U~it J <br /> Servl~ Included: It.s C~t (each) Sum/ <br /> <br /> 1~ S . fL ~less $05.00 <br /> Ea~ ~]~ 5~ sq. ft. -- 4 <br /> or ~m ~emd ~ $15,00 <br />~d <br /> ~ [ $~.o0 <br />~h M~ard amc or M~u~ <br />Dwe~g Se~m or Feeder $40.00 2 <br /> <br />B. Servi~ or Pe~ers (D~s not M~cude branch cintra, see seefi~ D) <br /> Ins~lation~ Alt~aflons or Rd~ation <br /> <br /> 200 amps or less $50.00 <br /> 201 amps to 400 amps $60.00 <br /> Gl amps to 6~O amps <br /> 601 amp to 1000 amp $130,00 <br /> Over 1000 amps or volu $;~00,00 <br /> Reconnect oaly SdO,00 <br /> <br /> C, Temporary Services/Feeders <br /> Ins~]tstion, Alteration, or <br /> 200 amp~ or less $@~,00 <br /> 201 amps to 400 amps $40.00 <br /> 401 amps to 600 amp~ $80,00 <br /> Ore,r, 600 amps or 1000 volts <br /> <br />D, Branch Circuits <br /> New, Alteration, or Extension Per Panel <br /> <br /> a) The fee for branch drcaits with <br /> <br /> Each branch clmu~t $2.00 <br /> <br /> b)Th~ fcc for braoeh c;ircata without <br /> rmrcha~e of.sepficc or feeder <br /> <br /> F~t branch ci<uit $~$.00 <br /> Each additional branch alreu~t $~,00 <br /> <br />E, MiscellaneOuS (Servlce or Feeder Not Included) <br /> ~ach Immp or irSgati(m circle $40,00 <br /> Each sign or oufllne l~ghting __ SA0.00 <br /> S~gnal e.~uit (a) or a limited enemy <br /> panel, alteration or extension $40.00 <br /> <br />E Each addBinnal Inspection <br />OVer the allowable in any of the <br />above, per ~n~e~tlon $$,5,00 <br /> <br />G. Minor In~tallation Labels <br />Pack of I0 labels @ $5,00 each $S0.00 <br />(~old only to electrical contraetom) <br /> <br />H. Other <br /> ( As req~red by B~ilding Off, eta0 <br /> <br />2 <br /> <br />5. vZ .s <br /> A L Euter torsi o£ £ees from Sec, #4 <br /> A2, Add 5% sumha~e <br /> <br /> Subtoml <br /> <br /> g. Enter ~% of ~e A1 for ~ Review <br /> (S<. 3), if ~ <br /> C, Iuvesfigafi~ Fee ~ui~d) <br /> D. Re~s~efim Fee <br /> <br /> TOTAL AMOUm' DUE <br /> <br /> Receipt No. , <br /> <br /> <br />