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FOR OFFI(~E USE ONLY Received by:. Date: 220 High Street NE Salem, Oregon 97301 P~one $88-5147 8.~0 am - 4:30pm Code-A-phone: 588-7904 FAX: 588-7948 ELECTRICAL PERMIT APPLICATION ] I Please complete all Sections, I through 5 SITE #: Date: Issued by: 1. LOCATION OF INSTALLATION PERMITS ARE NON-TRANSFERABLE AND NON-REFUNDABLE AND EXPIRE IF WORK IS NOT STARTED WITHIN 150 DAYS OF ISSUANCE OR IF WORK IS SUSPENDED FOR 180 DAYS. 2A. CONTRACTOR INSTALLATION ONLY EleafiealCoutractor-r'~ It~¢'hO..q~A ~l~C{.[Phone SoS° Property Owner ] Phone kJ No. 2B. FOR OWNER INSTALLATIONS Property Owner Mailing Address ] Phone City/State/Zip The installation is being made on property I own whi~ is not inamded for sale, lease, or i~nL Owner's Signatum 3. PLAN REVIEW SECTION We will provide plan review service if you Complete Section 5B and submit two (2) sets of plans and specifications with this application. This optional plan review program does not suspend the required submission of lighting power calculations, plans, and specifications when required by the Oregon Structural Specialty Code, Chapter 53. blC15-34 11/91 4. FEE SCHEDULE (Complete and enter total in Al below) A. ReMdential Per Unit Service Included: 1000 sq. f~ or less Each additional 500 sq. ft. ot portiou thereof $15.00 Limited Energy $~0.00 Each Manm°d Home or Modular Dwelling Service or Feeder $40.00 B. Services or Feeders (Does not inlende branch circuits, see section D) lnstall*tinn, Alterations or Reloea~on Co Do Number of Inspections per permit allowed -~ [ Items Cost (each) Sum/ $85.00 ~ 4 ,2 200 amps or less $50.00 2ol amps to 4oo amps $50.00 401 amps to 600 amps $100.00 601 amps to 1000 amps $130.00 Over 1000 amps or volts $300.00 Reconnect only $40.00 Temporary Service~Teeders Instailition, Alteration, or Relocation 200 amps or less $35.00 201 amps to 400 amps $40.00 401 amps to 600 amps $80.00 Over 600 amps or 1000 volts see "B" above Branch Circuits New, Alteration, or Extension Per Panel a) The fee for branch circuits with ~urchase of service or feeder fee Each branch circuit $2.00 b) The fee for branch circuts without purchase of service or fe.~.d~ f~ First branch circuit $35.00 Each additional branch circuit $2.00 g.. Miscellaneous (Service or Feeder Not Included) Each pump or tm'gation circle $40.00 , ,, Each sign or outline lighting $40.1)0 Signal circuk(s) or a limited energy panel, alteration or extension $40.00 F. Each additional Inspection over the allowable in any of the above, per Inspection $35.00 . . G. Minor Installation Labels Pack of 10 labels @ $5.00 each $50.00 (sold only to electrical contractors) (As required by Building ~fficta0 / ~' ~ 6 5. FEES Al. Enter total of fees from Sec. #4 $ A2. Add 5% surcharge (.05 x Al) $. Subtotal $ ,/.g'-~. B. Enter 25% of line A1 for Plan Review (Sec. 3), ff required $ C. Investigation Fee (if required) $ D. Reinspectiou Fee ($25.00) $ TOTAL ~OLrNT DUE $ / Receipt No..