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EOR ~)FFICE ....... I ~.~,~RIO15[C, OIIN~Y~UILDING INSPECTION <br />Received by: I ~ Salemi~gon 97301 <br />Date: I ' ;~ - <br /> ~-A-~me: 588-7~4 <br /> <br /> ELECTRICAL PERMIT APPL~&T~ iNq~Cii0N Date: <br /> Please complete ali Sections,-r <br /> ' <br /> <br /> L L~ATION O~IN~ALLATION <br /> <br />PermitNo. <br /> <br />PFALM1TS ARE NON-TR.4~$FRRABLB AND NON-REFUNDABLE AND <br />EXPIRE I~ WORK IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE: <br />OR IF 1VORK IS SUSPFfl~'DED FOR 1 $0 DAYS. <br /> <br />CONTRACTOR INSTALLATION ONLY <br /> <br /> C0ntractofs Soard ReS. No. ~3oQ~ <br />"Signature,, of SuI~rvising. Elae[rieian..~ .~/~,,~, ~..,_~.. , i <br /> <br /> FOR OWNER INSTALLATIONS <br />Pmp~ay Owner <br /> <br />Mailing Address Phone <br />City/Stater£ip : I <br /> <br />File mslallauon ~s being made on property I own whtOl Is nei inmded for sale,, <br /> <br />O~mer's Signature .... <br />3, PLAN REVIEW SECTION , , <br /> <br /> will proytde plan re,new service If you complete Section; <br /> 5B and submit two (2) sets of plans and specifications With :i <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 required by the Oregon Structural <br />Specially Code, Chapter 53. <br /> <br /> Issued by: <br /> <br />SCHEDULE (Complete ~nd enter Wtal b~ A 1 below) <br /> <br />A. Residential Per Unit <br />Service Included: <br /> <br /> 1000 sq, fl. or less <br />]~ach additiotml ~00 sq. fi. <br /> or portion [hereof <br /> <br /> 200 amp~ or less $50,00 <br /> <br /> R~eeonneet ot11¥ $40,00 <br /> 200 amps or less $~5,00 <br /> <br /> a) The fee for branch dmults with <br /> ~ch branch ~¢uit $2,00 <br /> ~ sevriee or feeder fee <br /> <br />E, Miscellaneous (Service or Feeder Not Included) <br /> <br /> Each sign or outline lighting Sd0,00 <br /> <br /> over the allowable in any of the <br /> above, per InsPection $~5.00 <br /> <br /> Pack of 10 labels @ $5-00 each $50.00 <br /> <br /> (As r~q~drcd by Building Official) <br /> <br />5. FEES <br /> Al. Enter total of fees £rom See. g4 , $$ <br /> A2, Add <br /> <br /> Subtotal $ <br /> <br /> (See. 3), ff t~quir~ $ ,,, <br /> C- InvestigatlonFee (ffrequired) $ <br /> D. Relnspectkm gee ($25.00) $ <br /> <br /> $85.00 <br /> <br /> $15.00 <br />T $20.00 <br /> <br />MC 15-34 11/91 <br /> <br /> <br />