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FOR OFFICE USE ONLY <br />I Received by:. __ <br />I Date: <br /> <br /> 220 High Street NE <br /> Salem, Oregon 97301 <br /> <br /> Phone 588-5147 8:00 am - 4:30pm <br /> Code-A-Phone: 588-7904 <br /> FAX: 588-7948 <br />ELECTRICAL PERMIT APPLICATION / <br />Please complete all Sections, I through 5 <br /> I <br /> <br />P ERaM~('I ~S ARE NON-TRANSFERABLE AND NON-REP~JNDAB LB AND <br />EXPIE. Ii IF WORK IS NOT STARTED WITIIIN 180 DAYS OF ISSUANCE <br />()R IF WORK IS SUSPENDED FOR 180 DAYS, <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br /> ........ <br /> <br /> .... <br />Pro~y Owner ~ <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br />Property Owner <br /> <br />Mailing Address "Phone~ <br />City/State/Zip <br /> <br />installation is being made on property I own which is not in[ended for ~ale. <br /> <br />Owrler'~ Signature , <br /> <br />3. PI,AN REVIEW SECTION <br /> <br />SITE #: Permit No. <br /> <br />Date: <br /> <br /> Issued by: <br /> <br />4. FEE SCFIEDULE (Complete and ente~ total m Al I~low) <br /> <br /> Nutober ut' Inspections per permit allowed <br /> <br />A, <br /> Resldel~tinl <br /> Per <br /> Unit <br /> Service Incladed: Item~ Cosl (each) <br /> <br />10~0 sq. ft. or less $8§,00 <br />Each additional ,500 sq. ft. <br />or portlc~ the~of $15.00 <br />Limited Energy $20,00 __ <br />Each Manufd Rome or Modular <br />Dwelling Service or Feeder -- $40,00 __ <br /> <br /> 200 aml~ or less SgO,00 <br /> 201 amps to 400 amps $$0,00 <br /> ~01 amp~ to 600 amp~ $100.00 <br /> 601 am ' to 1000 am~ <br /> Over I~P~ ~ amps or volts000 $300.00 $130.00 <br /> Reconnect c~tly $40,00 <br /> <br /> C, Temporary Servic~edei-s <br /> <br /> 2(10 amps or les~ $85.00 <br /> 201 amps to 400 amps $40.00 <br /> 401 amps to 600 aml~ $80.00 <br /> Over 600 amps or 1000 volts <br /> <br /> D. Branch Circuits <br /> <br /> a) ~IEe f~ for branch circuits with <br /> <br /> -Each bra/Ich circuit $2.00 <br /> b) The fee for branch circuta without <br /> <br /> Bach additional branch cimu/t ~ $2,00 <br />R, Misceaaneoo$ (Service or Feeder Not Included) <br />Bach pUmp or ir~gatlon circle $40,00 <br />Bach sign or oufllne !:~ghting $40,00 <br />Signal ekcuit(s) or a I,tm~od energy <br />l~nel, alteration or extension $40,00 <br />E, ~ach addRinnal Inspection <br />over the allowable in a~y of the <br />above, per Impecdon $35,00 <br />O, ~inor Installation Labels <br /> Pack of 10 labels @ $5,00 each $50,00 <br /> <br />H, Other <br /> ( A.r r*q~r~d by Building OfflciaI) <br /> <br />We will provide plan review service if you complete Section <br />5B and submit two (2) sets of plans and specifications with <br />this application. <br /> <br />This optional plan review program does not suspend the <br />required submission of lighting lmwer calculations, plans, <br />and specifications when required by the Oregon Structural <br />Specialty Cede, Chapter 53. <br /> <br />5. FEES <br /> A 1. Bater legal of fees from Sec, #4 <br /> A2. Add 5% surcharge (,05 x Al) <br /> <br /> Subtotal <br /> <br /> B. Enter 2$%oflineA1 for Plan Revicw <br /> (Sec, 3). if required <br /> C. TnvestigationFee (if required) <br /> D, Reinspecfion Fee ($25,00) <br /> <br /> 'I~)'I~,L AMOUNT DUE <br /> <br />$ <br /> <br />$ <br />$ <br /> <br />MC 15-34 11/91 Reeelpt <br /> <br /> <br />