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HomeMy WebLinkAboutPermit Building 2013-7-3 SPRINGFIELD 225 Fifth St • • CITY OF SPRINGFIELD Springfield,OR 97477 Liao °i Phone: 541-726-3753 *V OREGON Building / Residential Permit Inspection Phone: 541-726-3769 Fax: 541-726-3676 PERMIT NO: 811-SPR2013-01536 www.springfield-or.gov permitcenter @springfield-ocgov PROJECT STATUS: Issued ISSUED: 07/03/2013 EXPIRES: 12/29/2013 STATUS DATE: 07/03/2013 APPLIED: 07/03/2013 SITE ADDRESS: 960 16TH ST,Springfield,OR 97477 SCOPE: Hospital ASSESOR'S PARCEL NO: 1703362204603 TYPE OF STRUCTURE: Commercial PROJECT DESCRIPTION: Renovation of Heart Assoc.3rd floor-Mckenzie Med.Cntr 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 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 • - rxcuires you to • ATTENTION: ie- the Oregon Utility ©TILE: follow,qulQ dopted bY� Notif�catlon CD1t througheOAR 952 001- THIS PERMIT SHALL EXPIRE IF THE WORK in 0090. Your 001 Q es of the rules by AUTHORIZED UNDER THIS PERMIT IS NOT Oo9o. You may o tarn cop COMMENCED OR IS ABANDONED FOR calling the center. (ontUtil ty Notification ANY 180 DAY PERIOD. number for the Oreg Center is 1-800-332-2344). Springfield Building Permit 7/3/2013 3:09:49PM Page 1 of 1 • • SPRINGFIELD • CITY OF SPRINGFIELD 225 Fifth TRANSACTION RECEIPT Spr gfieldOR97477 ` EGON 541-726-3753 811-SPR2013-01536 www.springfieldor.gov 960 16TH ST permitcenter @springfield-or gov RECEIPT NO: 2013001443 - RECORD NO:811-SPR2013-01536 DATE:07/03/2013 IggA 7 7(: ligR t=am a '�^ _ =, lax •''ACCOUNT CODE/TRANS=.CODE t-r-1 +s : ii o Z Branch circuits without service or feeder- 1st circuit 224-00000-426102 1004 60.50 Branch circuits without service or feeder-each additional 224-00000-426102 1004 312.00 State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 44.70 Technology fee(5%of permit total) 100-00000-425605 2099 18.63 TOTAL DUE: 435.83 PAYMENTZYPEYF""aPAYORTskCASHIEP:JLARSON;a^as'' ?Ir.i;^'COMMENTS x_:11 atit"t'� ie:..h'AMOUNT PAID::pi t, ,fA ;ru_; Credit Card JK GUCKENBERGER ELECTRIC INC 435.83 055948 TOTAL PAID: 435.83 • • • Electrical Permit Application gPp1NGe1.,^ ,'): DEPARTMENT USE ONLY - '->->at am:25'4&}= uP:ip.o.vIA i 4k n: 9 1+'r. 5 vzv,r raw ea;,A,u xi +"E I. ,( 't�'' . $ RINGFF iD OR GOINF's .. V'/a9;y•: Permit no.:`all -Lc l'3 Ot 3C, +'lib. A, '6-a"@%w��db' .P .?iL'.1..,.,�§. .fSu+n;wL&:� "'"s'SR✓^.. . 225 Fifth Street,Springfield,OR 97477 PH(541)726-37539 FAX(541)726-3689 t Date: 7/3/ 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. `;:M LOCA.G GOVERNMENT-APPROVAIV;S - er.E '1V4iN.i-:?ngirt. :FEE SCHEDULE itt.Z,,r ,, +^WS t't' B •dbcon k3a1; aT �a ,sgq COStwq t"'TOtalt# Zoning approval verified? ❑ Yes ❑No Lumber, of mspegions p rtdem(e)sr pty ` ea „costa +.CATEGORY°OFF$CONSTRUCTION r. Residential,per unit,service included: ❑Residential ❑Government ❑Commercial JOB SITE INFORMATION AND LOCATION 1,000 sq.ft.or less(4) $134.00 $ �- Each additional 500 sq. R.or portion § 25.00 $ Job site address: 760 4 / 1-1-7 thereof City: qr.ttnr0C,c Jes State: 6) ZIP: 9 7'-17-2 Limited energy(2) $ 32.00 $ Reference: I(Taxlot: Each manufactured home or modular $ 63.00 $ DESCRIPTION 'OF WORK dwelling service or feeder(2) / ^ Services or feeders: installation,alteration,relocation 2 F✓/o LirvT(on o /-fir.r4-- .�i5oc • T J 200 amps or less(2) S 81.00 $ -P\oo Aace-,ztc 'med. Gc.4er , ;s _.s: ' r' PROPERTY-'.:OWNERxv. , 2T?Mi,s 201 to 400 amps(2) $ 95.00 $ ,,��ff�� /`l/ 401 to 600 amps(2) $158.00 S Name: Mr kkP✓171Y jc„cl .a/\ C ` 1 601 to 1,000 amps(2) $205.00 $ Address: cc./ LI,1\n MP Y` ST. / I © City: L.v p^c State: O j(` [ZIP: Over 1,000 amps or volts(2) $469.00 $ S Reconnect only(2) $ 63.00 $ Phone: - - Fax: - - 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 479.540(1)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 5h. .;_'°CONTRACTOR nINSTALLATION1st :7 "f; /4fl ,(= Branch circuits:new alteration,extension per panel Business name: L a.Fee for branch circuits with purchase of a service or feeder fee: Address:al 5'l tot,j .fr Each branch circuit $ 6.00 $ CitySe t Mr^F I e D State: d e_ ZIP:q rn b.Fee for branch circuits without purchase of a service or feeder fee: Phone:{(- "79(p- 4(pS(a Fax:c-(J r7q4; in SC First branch circuit(2) \ $ 55.00 $ —lxavx Each additional branch circuit (`� $ 6.00 $ CCB license no.:I-1'5 1291 BCD license no,: 20 - Cr)2 C. Miscellaneous fees:service or feeder not included Signing supervisor's license no.: t}G 7-SS Each pump or irrigation circle(2) $ 63.00 $ Print name of signing supervisor:k[f{ L.0(xLK( LIo try,,,e,l/ Each sign or outline lighting(2) $ 63.00 $ Signature of signing supervisor: alteration cui ex[enssion(d-energy panel, $ 63.00 $ • Each additional inspection:(I) $58.00 $ at,. . { t ,,:?APP.,LICANT1U3EMr'';s 1% 1 : r, ; (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): S l..J 3S 440-2584-1(9/08/COM) FROM JKG Electr lc Inc. (WED)JUL a 2015 11: 18/ST. 11 : 17/Ma. 7800000704 P l ( ` L fYI` l , DEPARTMENT USE ONLY lectrical Permit Application —. k Penntno.: 35 fifth Street•Springfield,OR 97477•P14(S41)726-3753•FAX(S41)726.3669 . - Date: Thin.permit is issued under OAR 910-309-00011. Permits are nontransferable. Permits expire if wadi is not started within 180 N VN days of issuance or if work is suspended for 100 days. LOCAL GOVERNMENT APPROVAL • - FEE SCHEDULE 4011412.apps oval verified? D Yes ❑ ()No Number of inspections per item Q Cost T0ta1 • ty. sa. cota CATEGORY OF CONSTRUCTION Residential,per unit,service included: ❑Residential ❑(iovemmenl I ❑Commercial 1.000 sq.ft.or less(4) $136.00 S JOB SITE INFORMATION AND LOCATION each additional 500 sq.ft.or portion $ 25.00 $ .lob site address: 9Ip 17 �- (,O ST thereof _, Cite': air IC(� .. Slate: •LU1: Limited energy(2) ,. . S 32.00 $ Subdivision: I_ol no.: Each manufactured home or modular $ 63.00 dwelling service or feeder(2) iDESCRIPTION OF WORK n/p✓/A"flak) O F 14v -'t stsc s�.//�� Services or feeders:installation, alteration, relocation 200 amps or less(2) c 67.00 S 1 ft° (Zs a A- —PKcdvs i e Med met Cc'vier,-PROPERTY OWNER 20-- o l to 400 amps(2) $ .00 $ 5158.00 $ Na 401 to 600 amps(2) __- Name: .—_- . 5205.00 $ - C-01 to 1.000 amps(2) Addtess: _ 1 $489 a0 $ ------ I Over 1,000 amps or volts(?) City: ___ __..I ZIP: I $ s3.0o $ ._ __ - - I Reconnect only(2) Phone: - - Fax: - - Temporary services or feeders:installation alteration, relocniiun 13 entail: 1 200 amps rn li. s(2) $ 63.00 E This installation is being made on residential or farm properly - owned by me or a member of my immediate family. This 201 to 400 amps(2) $ 87.00 S property is not intended for sale_exchange.lease.or rent.OAR I 401 In 600 amps(2) $126.00 I $ 479.540(1)and 47956)(1)- - Over 600 amps or 1,000 volts,sae services or feeders section above Signature: _ _ __ CONTRACTOR INSTALLATION Branch circuits:new.alteration, extension per panel 3 K� �t o f�`C J --rte a. Fee for brunch circuits with purchase of service or feeder Ice: Husiness name: ^�+ I ( 2151 j 1112 Each branch circuit ; $ 6.00 i $ Address. �STT r State: p %IP. 4.17 b. Fee for branch circuits without purchase of a service or feeder fee: ���///"' . r, � -146-3gSS First branch errant(2) I � $ 55-00 $ 5S Phone: �---��I -((��7'� �0-`Tp�O I Iras:S ,p ii.-nwil: lBR.)KEG-. -YV) Each additional branch circuit 1 921 $ 6.00 $iS .. 45 I lm I Miscellaneous fees:service or feeder not included CCI3 license no BCD license no.: 2�-bl"I L --' -- I Each pump or imgarion circle(2) S 63.00 $ Signing supervisor's license no.: 4815S S 63.00 S ,r e I ' Each sign or outline lighting(2) Print name of signing supervisor:. Signal circuit or a limited-energy panel. S 63.00 $ Signature at signing supervisor: -- alteration.or extension(2) _ Each additional inspection:(I) + 556.00 $ r APPLICANT USE (A) Enter subtotal of above fees $ 343 _ (Minimum Permit Fee$58.00) (8)Enter 12%surcharge(.12 x IA)) $ . V r--( (c)'fcchnolOgy Fee(5%of(AO $ _ r TOTAL fees and surcharges(A through C): $ I WA JL)-`5s-