1. Electrical Permit Application
Department of Consumer & Business Services
Building Codes Division· Lake County Contract Office .
513 Center St., Lakeview, OR 97630
(541) 947-6033, Fax: (541) 947-2144
Web: bcd.oregon.gov
This permit is issued under OAR 918-309-U000. Permits are nontransferable. Permits expire if work is not started within 180
days ofissuance or if work is suspended for 180 days.
.Number of inspections per item ( ) Items Cost ea. Sum
Residential, per unit, service included:
Job site address: 1,000 sq. ft. or less (4) p;106.00
City/State/ZIP: Each additional 500 sq. ft. or portion thereof $19.00
Limited energy (2) $25.00
Project name:
Each mmufactured borne or modular
Directions to job site: $63.00
dwelling service or feeder (2)
Multifamily residential (1) S45.00
Services or feeders: (installation, alteration, relocation)
Subdivision: Lot no.: 200 amps or less (2) :} $79.00 II Sr3 ' 2-
201 to 400 amps (2) $94.00
~.!52..~~Xl1JU¥-lLJ,,~:>L.:~d..J<!,~~~.L..:::~~~~~~~]. 401 to 600 amps (2) )156.00
601 to 1,000 amps (2) p;204.00
Over 1,000 amps or volts (2) js469.00
Name: Reconnect only (2) / $63.00
Address: Temporary services 6'r feeders: (installation, alteration, relocation)
CitylStatelZIP: 200 amps or less (2) $63.00
Phone: ( ) Fax: ( ) 201 to 400 amps (2) $86.00
This installation is being made on residential or farm property owned by 401 to 600 amps (2) p;125.00
me or a member of my immediate family. This property is not intended Over 600 amps or 1,000 volts. See services or feeders section, above. "
for sale, exchange, lease, or rent. ORS 479540(1) and 479.560(1). Branch circnits: (new, alteration, extension per panel)
~ion hp.Tp,,: a. Fee fur branch circuits with purchase of a service or feeder fee:
Carl Tracy Electric LLC. Each branch circnit -z... $4.00 'b OV
P.O. Box 1093 b. Fee for branch circuits without purchase of a service or feeder fee:
Lakeview Oregon 97630 First branch circuit (2) $54.00
PH. 541-947-2216--Fax 541-947-2661
Each additional branch circuit $4.00 "
CCB--169846 BCD--C174
Miscellaneous: (service or feeder not included)
Each pump or irrigation circle (2) $63.00
CCBlic.:
Each sign or outline lighting (2) $63.00
Signal circuits(s) or a limited-energy panel,
Signature: alteration, or extension (2) S63.00
If paying by credit card, applicant ' Hourly rate (number of hours) 11 $86.00
box. Do not send cash. Each additional inspection: (1) S55.00
,
o Visa o MasterCard o Discover
"
Phone: ( ) ".
I 7011111195 (A) Enter total of above fees /6b
Credit card number ExpiIation 70111/1291 (B) Enter 12 percent surcharge (.12 x [AD
7011111195 (C) Plan review, ifrequired (.25 x [AJ)
Name of cardholder as shown on credit card TOTAL fees and surcharges:
$
Cardholder signature Amount DCBS fiscal use only:
I ~~~~~
~J3USINESS
)LSERVICES
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2. ~ Lake County Building Department
/ . 1-~~;/4<~ 513 Center Street
) (541) 947-6033
-,
~-"--<:-/ / Lakeview, OR 97630 (541) 947-2144 fax
ILAKE COUNTyl
INSPECTION REQU!iST
Date requested: 8)2 :20 I) I Time: .•..
Type of inspection: ELEel ~5EEVrcL~
Owner.j-,'
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J./11
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Phone: )qJ-.j 7- :;2~/ b
)5Electrical
o Plumbing
.I
/ 0 Str~ctura'l o Mechanical o Manufactured home
Permit no.:£:: LI/ Lf! 090 I Requested by: f7.,4 LL I Contractor: ( ~£L I/2ACL-I
'I . /
Job address: /~7oo9 CuJ-.!oU,lCi ~rC);JE -;?;~KFVz-£"u)
/ /
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Directions: / /
,
Ready (date): g/ ;;L/ 'd--O I / o Mon. o Tue. OWed. ~Thu. o Fri. o A.M. o Mid o P.M.
Call before cormng? . 0 N DYes
/
. I
Phone: ( 0 )
INSPECTION REPORl .~.
Date inspected: ~·A lAG- .~-1'ime: Type of inspection: ~'-I 0;:::::
o Unable to inspect ~o corrections noted-- -' o Correction(s) expected within days
Inspection report no.:
~------ .---/
o Correction(s) noted: (Page of )
,
,
,
o Reinspection required prior to approval o OK to continue after corrections made
o Owner/contractor must sign below to indicate all corrections are made; return form to inspector.
Owner/contractor signature:
o Call for reinspection ..
Inspector name:
..-.--
~ Inspector signature: -tt-
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