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HomeMy WebLinkAboutPermit Electrical 2013-10-17 SPRINGFIELD • 225 Fifth St CITY OF SPRINGFIELD Springfield,OR 97477 :� ` Phone: 541-726-3753 OREGON Building / Commercial Permit Inspection Phone: 541-726-3769 Fax: 541-726-3676 PERMIT NO: 811-SPR2013-02315 www.springfield-or.gov pe nnitcenter @springfield-or.gov PROJECT STATUS: Issued ISSUED: 10/17/2013 EXPIRES: 04/15/2014 STATUS DATE: 10/17/2013 APPLIED: 10/17/2013 SITE ADDRESS: 6650 THURSTON RD,Springfield,OR 97478 SCOPE: Electrical Only ASSESOR'S PARCEL NO: 1702341102405 TYPE OF STRUCTURE: Public • PROJECT DESCRIPTION: Service and brach circuits for chlorine monitor OWNER: PEARSON IVAN Phone Number: ADDRESS: 1223 LITTLE JOHN LN EUGENE OR 97401 CONTRACTOR INFORMATION Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone Electrical Contractor OLSSON INDUSTRIAL ELECTRIC INC GCB 63473 01/26/2015 541-747-8460 INSPECTIONS REQUIRED Inspections 4225 Service or Feeder 4500 Rough Electrical Rough Electric: Prior to Cover 4999 Final Electrical Final Electric: When all electrical work is complete. By signature, I state and agree,that I have carefully examined the completed application and do hereby certify that all information hereon is true and correct, and I further certify that any and all work performed shall be done in accordance with the Ordinances of the City of Springfield and the Laws of the State or Oregon pertaining to the work described herein, and that NO OCCUPANCY will be made of any structure without permission of the Community Services Division, Building Safety. I further certify that only contractors and employees who are in compliance with ORS 701.005 will be used on this project. I further agree to ensure that all required inspections are requested at the proper time,that each address is readable from the street,that the permit card is located at the front of the property, and the approved set of plans will remain on the site at all times during construction. Owner or Contractor Signature Date ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth in OAR 952-001-0010 through OAR 952-001- goT`CE: L1-EXPIRE IF THE WDRK 0090. You may obtain copies of the rules by THIS PERM IT SHA THIS PERMIT IS NOT calling the center. (Note: the telephone AUTHORIZED UNDER number for the Oregon Utility Notification COMMENCED OR IS ABANDONED FOR Center is 1-800-332-2344). ANY 180 DAY PERIOD- Springfield Building Permit 10/17/201 2:56:37PM Page 1 of 1 • • .SPRINGFIELD i cry OF SPRINGFIELD d d 225 Fifth St Ike.* TRANSACTION RECEIPT Springfield,OR97477 OREGON 541-726-3753 811-SPR2013-02315 www.springfield-or.gov 6650 THURSTON RD permitcenter©springfield-or.gov RECEIPT NO: 2013002299 RECORD NO: 811-SPR2013-02315 DATE: 10/17/2013 (DESCRIPTION_ ACCOUNTT CODEITRANS_CODE. - - AMOUNTDUE Branch circuits with service or feeder each circuit 224-00000-426102 1004 13.00 Services 200 amps or less 224-00000-426102 1004 89.00 State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 12.24 Technology fee(5%of permit total) 100-00000-425605 2099 5.10 TOTAL DUE: 119.34 PAYMENT TYPE__:__PAYOR__CASHIER:DBOwLSBY 1„ _COMMENTS_-,^j__ _ _AMOUNT PAID- ` _ rJ Check OLSSON INDUSTRIAL ELECTRIC INC 119.34 65046 TOTAL PAID: 119.34 Electrical Permit Application DEPARTMENT USE ONLY ,r„ p •'.— + „r - SPRINGFIELD ' ; CITY OF SPRINGFIELD; OREGON ' ( Permit no.: 6 (3 -23?Y f 225 Fifth Slreet•Springfeld,OR 97477•P11(541)726-3753•F\X(541)7263689 \OREGON Date: /O/( 2 ( 3 This permit is issued under OAR 918-309-0000. Permits are nontransferable. Permits expire if work is not started within 180 days of issuance or if work is suspended for 180 days. 1 LOCAL GOVERNMENT APPROVAL FEE SCHEDULE Zoning approval verified? ❑ Yes ❑ No Number of inspections per item () Qty. Cost Total CATEGORY OF CONSTRUCTION ea. cost Residential,per unit,service included: 1 ❑ Residential ❑ Government ❑Commercial JOB SITE INFORMATION AND LOCATION 1,000 sq. 0.or less(4) $147.50 $ Each 4-1 there additional 500 sq. ft.or portion $ 27.50 $ Job site acldress:.ggg-y-Eg7ry (�6,�-��S ,� thereof City: SPRINGFIELD State: OR j ZIP: 97477 Limited energy(2) $ 35.00 $ Reference: 70 Z. 3 t{ ( ( Taxlot.:O e tics.r Each manufactured home or modular $ 69.00 $ DESCRIPTION OF WORK dwelling service or feeder(2) NEW SAMPLING STATION • Services or feeders:installation,alteration.relocation • • . 200 amps or less(2) 1 $ 89.00 $ 89 i �2OPERTY OWNER ,, _/ 201 to 400 amps(2) $ 104.50 $ I Name: SUB (/ 0071 /VJi-Iy 401 to 600 amps(2) $174.00 $ Address: 6 ' Q i-t \L 601 to 1,000 amps(2) $225.50 $ Q,. City: S f r41 State: G$(L, ZIP: V 71/76 Over 1,000 amps or cults(2) $516.00 $ Reconnect only(2) $ 69.00 $ Phone: - - Fax: - - E-mail'. Temporary services or feeders: installation, alteration, relocation 200 amps or less(2) $ 69.00 $ ' This installation is being made on residential or farm property 1 owned by me or a member of my immediate family. This 201 to 400 amps(2) $ 96.00 $ property is not intended for sale,exchange, lease, or rent. OAR 479.540(1)and 479.560(1). 401 to 600 amps(2) _ 5138.50 $ Signature: Over 600 amps or 1,000 volts,see services or feeders section above ' CONTRACTOR INSTALLATION Branch circuits: nev, alteration, extension per panel I Business name: OLSSON INDUSTRIAL ELECTRIC, INC a. Fee for branch circuits with purchase ofa service or feeder fee: I Address: PO BOX 70413 Each branch circuit 2 $ 6.50 $ 13 City: SPRINGFIELD Slate: OR ZIP: 97475 b. Fee for branch circuits without purchase ofa service or feeder fee: ('hone: 541 747 8460 Fax: 541_747-4846 First branch circuit(2) $ 60.50 $ E-mall: Each additional branch circuit $ 6.50 $ CCB license no.: 63473 BCD license no.: 20-241C Miscellaneous fees:service on j erfer not included Signing supervisor's license no.: 3334S Each pump or irrigation circle(2) $ 69.00 $ Print name of signing supervisor: DOUGLAS HEER Each sign or outline lighting(2) $ 69.00 $ Signature of signing supervisor: Signal circuit or a limited-energy panel, $ 80.00 S S b S P 4"7G alteration.or extension(2) Each additional inspection:(I) $80.00 $ APPLICANT USE (A) Enter subtotal of above fees (Minimum Permit Fee 580.00) $ 102 (B)Enter 12%surcharge(.12 x IA)) $ 12.24 • 1 (C)Technology Fee(5%of[Al) $ 5.10 440-2584-1(4/0 1201 3/COM) TOTAL fees and surcharges(A through C): $ 119.34 I I