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°mc . om, ] <br />Received by: <br />Date: <br /> <br /> 220 High Street <br /> Salem, Oregon 97301 <br /> <br />Phone 588-5147 8:(10 ~n - 4:30pm <br />Code-A-Phonm 588-7904 <br /> FAX: $88-7948 <br /> <br />ELECTRICAL PERMIT APPLICATION <br />Please complete all Sections, 1 through 5 <br /> <br />....... ~,~z. 0,,,,, ,~ <br /> P~ ~E NON-~S~BLE ~ NON-~AB~ ~ <br /> E~E ~ WORK KS NOT STUD ~ 180 DAYS OF ~SU~CE <br /> OR · WORK [S SUSP~ED FOR 180 DAYS, <br /> <br />FOR OWNER INffrALLATIONS <br /> <br />Prol~rty Owner <br />Mail~s Address Pho~ <br /> <br />Ovma?s Signature <br /> <br />3. PI-~N REVIEW SECTION <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 applic*tipn. <br /> <br /> This optional plan review program does not suspend the <br /> required submission of lighting power calculations, plans, <br /> and specifications when required by the Oregon Structural <br /> Specialty Code, Chapter 53. <br /> <br />MC 15-34 11/91 <br /> <br />4. FEE SCHEDULE (Com~ ~nd ~nt~r total i~ A I b~low) <br /> <br /> Per <br /> Unit <br /> / <br /> <br />10/X) sq. ft. or less .... $85,00 ...... 4 <br /> ~ ~c~f $15,00 <br /> <br /> ~ ~ ~ F~ ~0.00 ....... <br /> <br /> Inflation, AIt~ations ~ Rd~atlon ~ <br /> ~am~mless ~ ~¢.00 ~'- 2 <br /> <br />Temporary Servlce~ffeed~,s <br />2~ ~ps or.ss __ $55.00 <br /> <br />~1 ~gs to ~ am~ ~ $~.00 <br />~er ~ ~ps or 1~ mits <br /> <br />New, AIt~atlon, or ~mslon <br /> <br />a) ~ f~ <br /> <br /> .~rchase of s~wice <br /> F~t ~nch ~muit $~.00 <br /> <br /> ~ch ~mp ~ ~gafi~ cite $40.00 <br /> ~ s~ ~ ~ Ugh~mg ~ $40.00 <br /> <br /> Subm~ $ <br /> ~TAL~O~ DUE <br /> <br />No. <br /> <br /> <br />