HomeMy WebLinkAboutPermit Electrical 2013-9-16 SPRINGFIELD 225 Fifth St
CITY OF SPRINGFIELD Springfield,OR 97477
(`t ^t Phone: 541-726-3753
' ` OREGON Building / Commercial Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2013-02072
www.springfield-or.gov permitcenter @springfield-or.gov
PROJECT STATUS: Issued • ISSUED: 09/16/2013 EXPIRES: 03/15/2014
STATUS DATE: 09/16/2013 APPLIED: 09/16/2013
SITE ADDRESS: 1460 G ST,Springfield,OR 97477 SCOPE: Electrical Only
ASSESOR'S PARCEL NO: 1703362204601 TYPE OF STRUCTURE: Commercial
PROJECT DESCRIPTION: Two Chillers
OWNER: MCKENZIE WILLAMETTE REGIONAL MEDICAL CTR Phone Number:
ADDRESS: 14400 METCALF AVE
OVERLAND PARK KS 66223
L CONTRACTOR INFORMATION
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
Electrical Contractor JK GUCKENBERGER ELECTRIC INC GCB 45129 04/24/2014 541-746-4656
INSPECTIONS REQUIRED
-
Inspections
4200 Reconnect Service
4210 Service Change
4500 Rough Electrical Rough Electric: Prior to Cover
4550 Limited Energy
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
NOTICE:
THIS PERMIT SHALL EXPIRE IF THE WORK ATTENTION: Oregon law requires you to
AUTHORIZED UNDER THIS PERMIT IS NOT follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth
COMMENCED OR IS ABANDONED FOR t in OAR 952-001-0010 through OAR 952-001-
N 180 DAY PERIOD. c� L 0090. You may obtain copies of the rules by
p te: tine telephone
`✓ numberCalling for the the center.Oregon(No Utifity Notification
Center is 1-800-332-23:4).
Springfield Building Permit 9/16/2013 9:23:23AM Page 1 of 1
SPRINGFIELD - CITY OF SPRINGFIELD
225 Fifth St
TRANSACTION RECEIPT Springtield,OR 97477
82)
t'ff OREGON 811-SPR2013-02072 541-726-3753
www springfield-or goy 1460 G ST permitcenter@springfield-or gov
RECEIPT NO: 2013002034 RECORD NO:811-SPR2013-02072 DATE:09/16/2013
!DESCRIPTIONY.— - ACCOUNT CODEITFiANSCGDE AMOUNT;OUE...d
Branch circuits with service or feeder each circuit 224-00000-426102 1004 52.00
Service reconnect only 224-00000-426102 1004 69.00
Services 200 amps or less 224-00000-426102 1004 89.00
Services 601 amps to 999 amps 224-00000-426102 1004 225.00
Signal circuit(s)or limited-energy panel, alteration, or extension 224-00000-426102 1004 69.00
State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 60.48
Technology fee(5%of permit total) 100-00000-425605 2099 25.20
TOTAL DUE: 589.68
PAYMENT_TYPE: PAYOR CASHIER:JLARSON COMMENTS :1,•./.„ AMOUNT PAID
Credit Card JK GUCKENBERGER ELECTRIC INC 589.68
025809
TOTAL PAID: 589.68
•
•
Electrical Permit Application :.•• •DEPARTMENT-pSEONLYgi:Ai'
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(CITKOEISPREST. . t • 1 NI -% ) -4/11E.GONSa .,±i-ri- --=,',..,2,,,, -•,- Permit no.: 8 1 I 72z5 61207--
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225 Fifth Street•Springfield,OR 97477*PH(541)726-3753•FAX(541)726-3689
Date: q
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.
f(f.kgAIMILOCALIGPMERNmENVARPROVAL?:-jnatre :7;...g1:0111044.4iFEB;.1.SCHEDUtEratjska.:Maa4
Zoning approval verified? D Yes D No ./,'4/i74/VIAVI*StagieWa/;Vistrag'/AV IWri-Str.j NTalr-4
:misfumberepaspecpopxy:perifent(4)tc4 pty. - -iam,:,,,s-cezni,t;
CATEGORT,.000NSTRUCTIONr.2-',:-7:1:4.7, ;,] 4 -.43`'P4'".m '' "•-';
Residential,per unit,service included:
El Residential 0 Government 0 Commercial
JOB SITE INFORMATION AND LOCATION
1,000 sq. ft.or less(4) $134.00 $
3
Each additional 500 sq ft.or portion
Job site address: /'/6c7 6.r 51-.. thereof $ 25.00 $
City: ctrid, State: 04 ZIP: Limited energy(2) $ 32.00 $
Reference: Taxlot.: Each manufactured home or modular
DESCRIPTION OF WORK : .2 dwelling service or feeder(2) $ 63.00 $
,. v . ,ti:.::•, ,. . ,,, r .
Services or feeders: installation, alteration,relocation
teet,/aee ext5Afra"
200 amps or less(2) j $ 81.00 $
4-kiaa.ce&WARRORERPCOWNERAnicina 201 to 400 amps(2) $ 95.00 $
Name: N■c_vy„,,-, ui, \_\Arc)_ c e-Are-P 401 to 600 amps(2) $158.00 $
Address: 601 to 1,000 amps(2) ,/ $205.00 $
City: State: ZIP: 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
479.540(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
VS.,04.;;W:CCONTRACTORIINSTALILATION:7 ,50 Branch circuits:new alteration,extension per panel
Business name: .:361 el..t...=C-1- e....1 c_ t- a.Fee for branch circuits with purchase of a service or feeder fee:
Address:0_1 5'l TbDt./ S---1-. Each branch circuit e $ L. $
cityks-eziw.,E.at b State: b e_ ZIP:'9 )1 77 b. Fee for branch circuits without purchase of a service or feeder fee:
Phone:S-4 I- ?-I 6- 44(05-(0 Faxictli r111 6, --371 SG- First branch circuit(2) ' $ 55.00 $
Each additional branch circuit $ 6.00 $
CCB license no.:145 I 2_9i BCD license no,: 20 -21') C.— Miscellaneous fees:service or feeder not included
Signing supervisor's license no.: LI-%7 Sic Each pump or irrigation circle(2) $ 63.00 $
Print name of signing supervisor:AN/ft( t)(1/rre,nNy0. r Each sign or outline lighting(2) $ 63.00 $
$ 63.00 $
Signal circuit or a limited-energy panel, /
Signature of signing supervisor: alteration,or extension(2)
. - •Each additional inspection:(I) $58.00 $
S•t ..•.44%00 P:L=IdA gtraiStinattigatletga
(A) Enter subtotal of above fees
$
(Minimum Permit Fee$58.00)
(B)Enter 12%surcharge(.12 x[A]) $
(C)Technology Fee(6%of[A]) $
TOTAL fees and surcharges(A through C): SC57 S-S—.
440-2584-1(9/03/COM)