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COMMUNITYDEVI~LOPM~NTC~NTI~R ~.~J{~"~'"~'~--"~ ~/~ <br /> 285 Church St NE · Room 132 ~T ' ~ <br /> Salem. OR 97301 ~1/~; ~ %~/[,I <br /> <br /> ~: ~88- ~48 ' Y: ~, tON <br />ELECTRJOAL pERMiT APPLIOATION ' [ <br /> P/ease complete ~1 Sections, 1 t~rough 5 ..[ 4. FS~ ~ (Complete mid 0,1t~ total in Al below) <br /> <br /> 1. LOCATION OF INSTALLATION <br /> <br /> pI~RM1TS ARI~ NON-TRANS~KABL~ AND ~XPIRE']F WORK IS N~rf <br /> STARTED WITHIN 180 DAYS OF ISSUANCE OR Il~ <br /> WORK IS SUspENDF~D FOR 180 DAY8, <br /> <br /> 2A. CONTRACTOR INSTALLATION ONLY <br />' l~leetrieal Contr,~ ~,~.*% ~1'~ Phone ~//-- ~"~ ...... <br /> <br /> ........ <br /> <br /> 2B. FOR OWNBR INSTALLATIONS <br /> <br /> Pmpe~y Owner (please <br /> Mailing AdOrc~ [ Phone <br /> <br />3. PL~ RENEW SBCTION <br /> <br />Mado~ County does ~ot require a ph~ review. <br />We will provide plan review se~ice ffyou complete <br />Secdon 5B and submit ~wo (2) <br />specifications with this application, <br /> <br /> R~identlal <br /> l%r <br /> Unit <br /> <br />1000 sq. ft. or I~ss ~ SS.~,O0 4 <br />~ach additional 5~ sq, fl, <br /> <br />Limited Energy $20,~) ~, ,~1 <br /> <br />200 amps or <br />201 amps lo400 amps <br />~t amps m ~0 amps <br />~i am~ to I000 <br /> <br />200 amps or less <br />201 am~ m ~0 <br />~1 a~n~ to ~ amps <br /> <br />a) ~e l~e f~ brach <br /> <br />b) ~c foe for <br /> <br />~ch addi~onal brmeh circuit <br /> <br />~ pump or i~atioa <br />~¢h si~ or outlin~ <br /> <br />~¢k of 10 labels <br /> <br />(~ required by Buildit~ <br /> <br /> sm.po 3"0 '-5 <br /> $00.00 ~ 2 <br />$ lO0,O0 ,,, 2 <br />$130,00 2 <br />$300.00 2 <br /> $40,00 ---- 2 <br /> <br />$35,00 2 <br />$40.00 2 <br />ggo,o0 2 <br /> <br />$35.00 <br />$ 2,00 <br /> <br />$40,00 2 <br />$4O,0O ~ 2 <br /> <br />$40.00 __2 <br /> <br />$35,00 <br /> <br />$50,00 <br /> <br /> __ sq. lL x $.06 = <br />#of Labels ~ <br /> <br />5. NEE8 <br /> A 1. I%ter total of fees £~m gcc, l/4 <br /> A2. Add 5% surcharge (.05 x Al) <br /> ~bt~al <br /> <br /> B, Enter 25% of line A 1 for Plan R~view <br /> (gee. ~), if mquimd <br /> C, Inveatigatlon Fee (if~quit~d) <br /> D. R~impeetion Peo ($25.~) <br /> <br /> TOT~ ~O~ DUE <br /> Receipt No. ~ <br /> <br />$ <br /> <br />$ <br /> <br /> <br />