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I~FOR ~FFICE USE ONLY <br />Received by.* <br /> Date: ' <br /> <br /> ELECTRICAL PERMIT APPLICATION <br /> Please complete all Sections, I through <br /> <br /> Salem, Oregon 97301 <br /> <br /> Phone 588-5147 8:~ ~ - 4:3~ <br /> C~e~A-mo~e: 588-7~4 <br />..... FAX: 588-7948 SITE <br /> <br /> Bate: <br /> <br />PEKMITS ARE NON-TRANSFERABLE AND NON-REFUNDAB111 AND <br />EXFI~E IF WORK IS NOT STARTED V/TfHI~ 180 DAYS OF ISSUANCE <br />OR IF WORK IS SUSPI~N'DED FOR 180 DAYS. <br /> <br />..... Mailing Addres~ ['hone <br /> City/State~ip <br /> <br />Thc hlslallafion is ~ing mad~ on prolmrty I own which is nO/intended for sale, <br /> <br />Owners Signato~ ...... <br /> <br />3. PLAN REVIEW SECTION <br /> <br />We will pcovide plan review service if you complete SectiOn <br />5B and sabmit two (2) sets of plans and specifications with <br />this application. <br /> <br />This optional plan review program does not suspend thc <br />required submission of lighting power calculations, plans, <br />and specificatious when required by the Oregon Structural <br />Specially Code, Chapter 53. <br /> <br /> Issued by: <br /> <br />d, IeEE SCHEDULE (Complete a~d enter total in A 1 below) <br /> <br /> ! <br />A. Residential Per Unit <br /> Service Included: It~ans Cost (each) Sum <br /> <br />1000 sq. ft. or less $85.00 ~ 4 <br />Each additional 500 sq, fl, <br />or poffion th¢mof $15.00 . ,, <br />Limited Enemy $20,00 -- 1 <br />]~a~.h Manu£d J~ome or Modular <br />Dw~m.s Se~,~ or F¢ode~ --/-- $40.00 t-/'a. ~'~a <br /> <br />C, Temporary Services/Feeders <br /> <br /> Ore ,r, 600 amps or 1000 volts <br /> <br /> a) The tee for branch elreuks ~ <br /> <br />E. Miscellaneous ($ervle~ or Fe~fler Not in¢ludtd) <br /> <br /> Pack of 10 labels @ $5~00 each <br /> <br /> ( A$ required by Beitding Official) <br /> <br /> ~50.00 2 <br /> 60.00 <br />$100.00 ....... 2 <br />$130.00 <br />$800.00 ....... 2 <br /> $40.00 __2 <br /> <br />$35,00 <br />$40.00 <br />$SO,O0 <br /> <br />$2.00 <br /> <br />$35,00 <br /> $2.00 <br /> <br />$40.00 <br />$40,00 <br /> <br />$40,00 <br /> <br />$35,00 <br /> <br />$50.00 , <br /> <br />5. FEES <br /> Al, Enter total of fee~ from Sec, #4 <br /> A2, Add 5% surcharge (,05 x Al) <br /> <br /> Subtotal <br /> <br /> B. Enter 25% of linc A 1 for Plan Review <br /> (Sec, 3), if teqaired <br /> C. lnvestigationFee (if required) <br /> D. Rcinsl~CfiCq~ Fee ($25,00) <br /> <br /> TOrAL AMOUNT DUE <br /> <br />$ q.2, ~ <br /> <br />MC 15-34 11/91 Receipt No. ,, __,,, <br /> <br /> <br />