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IFOR OFFICE USE ONLY <br />Received by: <br /> <br />Salem, Oregon 97301 <br /> <br /> Phone 588-5147 8:00 am - 4:30pm <br /> Code-A-Phone: 588-7904 <br /> FAX: 588-7945 <br /> <br />ELEGTRIC^L PEFtMIT APPLIGATION <br />Please complete all Sections, I through 5 <br /> <br /> MARION COUNTY <br />SITE ~[.J~.~9!N~ [.~!~P~~P~'mt~ No, <br /> <br />Date: <br /> <br />Issued by: <br /> <br />I, LOCATION OF iNSTALLATION <br /> <br />PERMITS ARE NON..TRANSF:~'RABLE J~uND NON-REFUNDABLE AND <br />EXPIRI5 IF WOKK Ig NOT STAI~.TED W1T'rlI~ IBO BAYS OF ISgU AaNCE <br />OR ~F WORK IS SUSPENDED FOP, 1 SD DAYS. <br /> <br />2A, CONTRACTOR INSTALLATION ONLY <br /> <br />Pm~ny Owner ] Phone <br />Contmc~fs~c~s~No, ....... ~ _./~ ~. ~ <br />Co,,~r~tor's Board K~g. No. ~ [~o. <br /> <br />ZB~ FOR O~ INSTAL~TIO~S <br /> <br />I <br /> <br />Owner's Signalum <br /> <br />3, PLAN REVIEW fiE(TrION <br /> <br />We will provide plan re'dew service if you complete Section <br />513 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 power calculations, plans, <br />and specifications when reqnircxl by the Oregon Structural <br />Specialty C(×le, Chapter 53. <br /> <br />Mt? 15-34 8/94 <br /> <br />4. FEE SCHEDULE (C~ml~.etc and e~,~r totat in A I ~low) <br /> <br /> Number ~ Insp~tions per permit allowed <br /> <br /> R~ldentlal <br /> Per <br /> Unit <br /> ~e~lce Included: It--s Cost (each) SUm/ <br /> <br />1~ sq, ft, ~]css $~,00 ~ 4 <br />~ach ad~aI 5~ sq, <br />~ffi~ thc~ol $15 <br />~tcd Bne~y $20.00 ~ 1 <br />E~h M~ufd Home or M~ular <br />Dw~ Se~m or Peedcr $40.00 ~ 2 <br /> <br /> ~ am~ ~ 1~ $50.00 , <br /> ~1 ~ to 4~ ~p~ ~ $60.00 <br /> <br /> ~1 aml~lto 1~1 amps $1 ~0.~ ~ 2 <br /> ~ $800.00 <br /> Re~ ~dy ~ $40.00 ...... 2 <br /> <br />C. Temporary <br /> <br /> 2~ ~p~ or less $35.00 <br /> 201 ~ps to 400 am~ ~ $40.00 2 <br /> ~1 ~ps to ~ amps ~ $80.00 ... 2 <br /> ~ef 6~ ~ps or 10~ volts <br /> <br />D, ~raneh <br /> <br /> a) ~c f~ f~ ~anch ~m~ts ~ <br /> <br /> Each brach ci~nit ~ $2.00 <br /> b) The f~ for ~nch 6routs w~am <br /> <br /> F~t branch ~rc~t $~5.00 <br /> m& ad~Qm~ b~nO ~uit ~ $2.00 <br /> <br />E, Mlscellan~us (Service or Feeder Not Include0) <br />~ch ~mp or i~gatm cirel¢ SdO.O0 ... 2 <br />~ch s~ or ~e hghfing $40.00 <br />Signal tire,it(s) or a h~md enemy <br />~nel, alteration or ext~sion $40.00 ~ 2 <br /> <br /> a~ve, ~r Inspection $35.00 <br /> <br /> Pa& d I0 la~s ~ $5.00 each $~0.00 <br /> (sold o~y to *le~trlcal gontraclor~) <br /> <br />H, Other <br /> ( A~ mq~red by Building OfficiaO <br /> <br />5. FEES <br /> Al. Enter total of fees from Sec. #4 <br /> A2. Add 5% surcharge (.05 x A I) <br /> <br /> Sobtotal <br /> <br /> B. P. nter 25% o[En~Al for Plan Review <br /> (Sec. 3). if required <br /> C. InvcsligationFee (ffrequEed) <br /> D. R¢inspe¢fion Fee <br /> <br /> 'IDTAL AMOUNT DUE <br /> <br /> Receipt No. <br /> <br />$3.,& <br /> <br /> <br />