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~ -AT YOUR SERVlC£ <br /> <br />BUILDING & SAFEff DMSION ,, 588-6242 <br />PERMIT APPUCATION CE~" 588-69.56 <br />City Hall / 555 Uberty St. SE / Room 320 <br />Salem, Ore<Jori 97301 <br /> <br />PID NO.: 12 570. 300 <br /> <br />ELECTRICAL PERMIT <br /> APPLICATION <br /> <br />LOCATION OF WORK: <br /> <br />ELECTRICAL CONTRAgTOR, L, <br />AI3ORESS: <br /> <br />CONSTRUCTI ON C-.ONTRACTORS <br />~D~ I~1~(~ <br /> <br />E~C~IC~ BUSINESS MCENSE ~: <br /> <br />ELECTRICAL SUPERVISOR'S LICENSE <br /> <br /> I. THE UNDERSIGNED. CERTIFY THE <br /> INFORMATION PROVIDED IS CORRECT <br /> <br />I AUTHORIZED SIGNA~RE <br /> <br />OWNER'S NAME <br /> <br />PHONE #: <br /> <br />THE INSTAt. L.~,TtON IS BEING IddkOE ON <br />PROPERTY I OWN WHICH IS NOT FOR <br />SALE. LEASE OR RENT. <br /> <br />OWNER'S SIGNATURE <br /> <br />PERMITS ARE NON-TRANSFERRABLE, <br />NON. REFUNDABLE AND EXPIRE IF WORK <br />IS NOT STARTED WITHIN 180 DAYS OF <br />ISSUANCE OR IF WORK IS SUSPENOEO <br />FOR 180 DAYS. DOUBLE FEES MAY BE <br />ASSESSED WHEN INSUFFICIEHT R'EMS <br />ARE INDICATED ON PERMIT. <br /> <br />Reference: OAR 918-309-0000 <br /> <br />EFF. 111/97 <br /> <br />TYPE OF WORK NO. FEE/EA AI~NT <br /> <br />NEW MULTI-FAMILY PER DWELUNG UNIT <br />SERVICES INCLUDED: <br /> <br />1000 SCl FT OR LEss ~5.00 <br />~ ADD1., 500 SQ FT OR PORTION THEREOF 15.q0 <br /> <br />UMITED ENERGY 20.~0 <br /> <br />E/L MANUF'D HOME OR MODULAR DWELLING <br />SERVICE OR FEEDER 40.00 <br />SE CES OR FEEDERS-,NST' "O". AL, TIO, TION <br /> 200 AMPS OR LESS <br /> 201 ,ed~f. PS TO 400 AMPS 60.00 <br /> 401 AMPS TO 600 AMPS 100JO0 <br /> 601 AMPS TO 1000 AMPS 130,00 <br /> OVER 1000 AMPS TO VOLTS 300.00 <br /> RECONNECT ONLY 40.00 <br /> <br /> TEMPORARY SERVICES OR FEEDERS - INSTALL, ALTER. OR RELOCATION <br /> <br /> [00 AMPS OR LESS 40.00 <br /> 201 AMPS TO 400 AMPS 55.00 <br /> 401 AMPS TO 600 AMPS 80,00 <br /> OVER 600 AMPS C~il ,000 VOLTS SEE SERV. ABOVE <br /> <br /> BRANCH CIRCUITS .NEW, ALTER OR EXTENSION PER PANEL <br /> <br /> THE FEE FOR BRANCH CIRCUITS <br /> PURCHASE OF SERVICE OR FEEDER FEE 2100 <br /> <br /> THE FEE FOR BRANCH CIRCUITS wrrHc;XJT <br /> PURCHASE OF SERVICE OR FEEDER FEE 35,00 <br /> <br /> EA. ADDITIONAL BRANCH CIRCUIT 2.00 <br /> MISCELLANEOUS [SERVICE OR FEEOER NOT iNCLUDED) <br /> <br />F.A. PUMP OR. IRRIGATION CIRCLE <br />EA. SIGN OR OUTMNE UGHT <br />SIGNAL CIRCUIT(S) OR A UMITEO ENERGY <br />PANEL ALTERATION OR EXTENSION <br /> <br />EA. ADD'L INSPECTION OVER THE ALLOWABLE <br />IN ANY OF TI'E ABOVE <br /> <br />REINSPECTION FEE <br /> <br />40,00 <br /> <br />40.00 <br /> <br />35.00 <br /> <br />1. PERMIT FEE ~'~ <br />2. 5% STATE SURCHARGE (5% ef Line 1) <br />3. PLANS REVIEW ( 25% of U~ 1) <br /> <br />MINOR ELECTRICAL LABELS: # TO <br />DWELMNG STICKERS: # TO <br /> <br /> <br />