The URL can be used to link to this page

Home My WebLink AboutPermit Electrical 2013-6-10 SPRINGFIELD 225 Fifth St "' — -• CITY OF SPRINGFIELD Springfield,OR 97477 Phone: 541-726-3753 ht(\ u \OREGON Building / Commercial Permit Inspection Phone:541-726-3769 Fax:541-726-3676 PERMIT NO: 811SPR2013-01204 www.springfield-or.gov permitcenter @springfeld-or.gov PROJECT STATUS: Issued ISSUED: ' 06/10/2013 EXPIRES: . 12/06/2013 STATUS DATE: 06/10/2013 APPLIED: 06/07/2013 SITE ADDRESS:' 960 16TH ST,Springfield,OR 97477 SCOPE: Electrical Only ASSESOR'S PARCEL NO: 1703362204603 TYPE OF STRUCTURE: Commercial PROJECT DESCRIPTION: Elevator Modernization OWNER: MCKENZIE MEDICAL LLC Phone Number: ADDRESS:• 541 WILLAMETTE ST STE 109 EUGENE OR 97401 • CONTRACTOR INFORMATION Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone Electrical Contractor JK GUCKENBERGER ELECTRIC INC CCB 45129 04/24/2014 541-746-4656 INSPECTIONS REQUIRED Inspections • 4210 Service Change 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 ATTc-NTIf,h'' "\.4) •• law requires you to .,i3TICE: foUgcF rLej, re.d by the Oregon Utility r,✓,,r^'1 ,,,:, (,enter. These rules are set forth [HIS PERMIT SHALL.EXPIRE IF THE WORK i Fl 9500 0010 through OAR 952-001- AUTHORIZED UNDER THIS PERMIT IS NOT 0090. You nay obtain copies of the rules by COMMENCED OR IS ABANDONED FOR calling the center. (Note: the telephun-s ANY 180 DAY PERIOD. - number for the Oregon Utility Notification Center is 1-800-332-2344). . Springfield Building Permit 6/10/2013 9:18:53AM Page 1 of 1 • SPRINGFIELD " CITY OF SPRINGFIELD ' ,. 225 Fifth St `'�R'E�oN TRANSACTION RECEIPT Spnngfeld,OR97477 541-726-3753 • 811-SPR2013-01204 www.spdngfield-or.gov 960 16TH ST permitcenter @spnngfeld-or.gov RECEIPT NO: 2013001168 RECORD NO:811-SPR2013.01204 - • DATE:06/10/2013 wi‘a4=:li tici't ci 'ra...�,°.. iwc. ffV.«' +' L',ACCOUNTiCODEITRANS CODE V ErAMOUNT DUE Branch circuits with service or feeder each circuit 224-00000-426102 1004 19.50 Services 200 amps or less 224-00000-426102 1004 89.00 State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 13.02 Technology fee(5%of permit total) 100-00000-425605 2099 5.43 TOTAL DUE: 126.95 BAYMENTRTYPE P.AYOR CASHIER:JLARSON a t= -,'a:COMMENTS • Credit Card JK GUCKENBERGER ELECTRIC INC - 126.95 015550 TOTAL PAID: 126.95 • • • • • • DEPARTMENTruSE`ONLYi i Electrical Permit Application „a,,,��,pt,. -.Y.< IeiC °,� w R] ZQ S Permitno.:elY2ol3 0120 { iaV c. °S6.giveS%14,4ara cla& t'.,.atRzW. dt . el 225 Fifth Street•Springfield,OR 974776 PH(541)776-3753•FAX(541)726-3689 Date: , /7 (I 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. flaiG,ALGOVERNINENTAP,:FROVAIXW __ , iti-rina,:r„EaNFEE%,SCHEDULE„a= „ .ter Zoning approval verified? 0 Yes ❑No � ..c� +sh y 1a;;1 m t a **r Ceoa s t° Ttal N"umber of mp,etonpr em(a)( Qty cost" ' i tCATEGORY)OF=CONSTRUCTION " Residential,per unit,service included: • ❑Residential ❑Government ❑Commercial 1,000 sq. ft.or less(4) $134.00 $ JOB SITE INFORMATION AND LOCATION a _ Each Job site address: '7722 6I hereof additional 500 sq. ft.or portion $ 25.00 $ City: S'P f/7 State:DK ZIP:9'7 y.77 limited energy(2) $ 32.00 $ Reference: Taxlot.: Each manufactured home or modular $ 63.00 $ :DESCRIPTION ;OF,.WORK: • ,. dwelling service or feeder(2) � NA J Services or feeders: installation,alteration,relocation 'L r ,v(ale1:0r/Zm 17o"t 200 amps or less(2) 1 $ 81.00 $ ;arc hits-m:rtiPROP.,ERrt OWNER+ a:i?e;'Mt aV 201 to 400 amps(2) l $ 85.00 $ Name: r[[ / ,I / 401 to 600 amps(2) $158.00 $ i N lti ta Address: $'y/ W ]it„-,e{-tie 5T (,p q 601 to 1,000 amps(2) 5205.00 $ City: e ,,,c e_ State: pcc ziPI 7 Ko 1 Over 1,000 amps or volts(2) $469.00 $ Phone: - - Fax: - - Reconnect only(2) $ 63.00 $ E-mail: Temporary services or feeders: installation, alteration,relocation This installation is being made on residential or farm property 200 amps or less(2) $ 63.00 $ owned by me or a member of my immediate family.This 201 to 400 amps(2) $ 87.00 $ property is not intended for sale,exchange, lease,or rent. OAR 479.5400)and 479.560(1). 401 to 600 amps(2) $126.00 $ Signature: Over 600 amps or 1,000 volts,see services or feeders section above Fza rt, 5CONTRACTOR: INSTALL'ATION,. + . 4 f _,`- Branch circuits:new, alteration,extension per panel Business name: 3 tes, ELL C-T c L a.Fee for branch circuits with purchase of a service or feeder fee: Address:ai 5 t )D J $—(-- Each branch circuit 5 $ 6.00 $ CiIY�P R t Ny F1e 1 D State: be_ ZIP:q fl4 rn b.Fee for branch circuits without purchase of a service or feeder fee: Phone:S-4 '7c((p- 4(p •(,, Fax:St-( ris-Ka 3' 5 First branch circuit(2) $ 55.00 $ E-mail:'t�'��jJ1�[ LLW\ Each additional branch circuit S 6.00 $ CCB license no.:11.5 1 211 BCD license no.: 20 2i'? L Miscellaneous fees:service or feeder not included Signing supervisor's license no.: t}$ 755' Each pump or irrigation circle(2) $ 63.00 $ Print name of signing supervisor: ('(74 &juju)) Kr. 4( Each sign or outline lighting(2) $ 63.00 $ Signature of signing supervisor: Signal circuit or a limited-energy panel, $ 63.00 s g g P alteration,or extension(2) Each additional inspection:(1) $58.00 $ (A) Enter subtotal of above fees $ (Minimum Permit Fee$58.00) (B)Enter 12%surcharge(.12 x[A]) $ (C)Technology Fee(5%of[A]) $ TOTAL fees and surcharges(A through C): $ Z6. 440-2584-1(9/08/COM) • FROM JKO electric Inc. (FRI )JUM 7 2010 12: 13/ST. 12: 13/140. 7600000SSS P l \ - �. -_.. .. ONLY -. IeLtr�cal Permit Application ` " r DEPAR T USE ONLY r irk .ki. PCITmlllll- 25 Fin Surer•Springfield,OR 97477•P11(541)726-3753•FAN(511)726.3689 Date: • Pt's ;.permit is issued under OAR 918-309-00011. Permits arc nontransferable.Permits expire if work is not started within 180 Q .ifily of issuance or if work is suspended for 180 days. O LOCAL GOVERNMENT APPROVAL I FEE SCHEDULE Cost Total toning approval verified'? ❑ Yes ❑ No Number of inspections per item 0) 101,2111,,*. o cost CATEGORY OF CONSTRUCTION Residential, per unit,service included: _Residential I ❑Government ['Commercial 5134,00 5 ❑ t- 1,000 sq.11_at less(4) JOB SITE INFORMATION AND LOCATION Each additional 500 sq.ft.or portion 25.00 S Job site address: '3b0 N•• thereof City' $ pF*-� .._... State:., - ZIP: Limited energy(2) - $ 32.00 $ Subdivision. Lot no.: Each manufactured home or modular S 63.00 $ dwelling service or feeder(2) _ DESCRIPTION OF WORK 1 d¢t2Nl city Services or feeders: installation. alteration, relocation E`4VZ /flw 200 amps or less(2) I S 81.00 $81 PROPERTY OWNER 201 to 400 amps(2) S 95.00 $ —..- -- 401 to 600 amps(2) $158.00 $ Name: _. - - 601 to 1.000 amps(2) $205.00 S Address: ---- { Over 1,000 amps or volts(2) $489.00 S ..Ili': Stale: _ ZIP: ____ Reconnect only(2) $ 83.00 S Phone: I }'as: - - Temporary services or feeders: installation, nitern/ion, relocation F.-mail: -- _ 200 amp:or less(2) 5 63.00 $ This installation is being made on residential or farm property owned by me or a member of my immediate family. This 201 to 400 amps(2) 5 87.00 S —.open%is not intended for sale.exchange-lease.or rent. OAR 401 to(10(I amps(2) I 5126.00 S )540(1)and 479560(I). -- -Over 600 amps or 1-000 volts;see services or feeders section above �lgnature, _ _ _ CONTRACTOR INSTALLATION Branch circuits:new', alteration, extension per panel Business name: 3 Kea, ( 0 (4YL L� cmn c, a. Fee for branch circuits with purchase of a service nr feeder fee: Address. 2_,l5"1 AP' 5o Each branch circus 1 S 6.00 $ • I State: QC) ZIP: Clitill b. Fee for branch circuits without purchase of a service or feeder fee: `�4( -^146-445 1 Fax:54-{ -14 -3gss First branch cirurii(2) I 5 55.00 S Phone 1 �3^JK tec�cum - Each additional branch circuit I 3 1 $ 6.00 $ \5, li-snail' l°� _ — �46 i Lei f BCD license no.: 2O-ZI1G M°eellaneous fm:service or feeder nor included t_'CIl license nn.: : - Signing super visor's license no.: 48155 Each pump or irrigation circle(2) S 63.00 S Each sign or outline lighting(2) S 63.00 S Print name of signing supervisor:34y/ _ ate" A "14 r r ----- - Signal circuit or a limited-energy panel, S 63.00 $ Signature or signing supervisor: .__.__ _ _ alteration.or extension(2) Each additional inspection:(1) $5800 $ APPLICANT USE - I (A) Enter subtotal of above fees 5 • (Minimum Permit Fee 558.00) (B)Enter 12%surcharge(.12 x IA]) • 5 (C)Technology Fee(5%of IA]) $ TOTAL fees and surcharges(A through C): S .258.1-4 C>•nwtronn •