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Home My WebLink AboutPermit Electrical 2013-9-25 • SPRINGFIELD 225 Fifth St ! 4 a-a- CITY OF SPRINGFIELD Springfield,OR 97477 f 1.., '1�� Phone: 541-726-3753 - OREGON Building / Commercial Permit Inspection Phone: 541-726-3769 Fax: 541-726-3676 PERMIT NO: 811-SPR2013-02121 www.springfield-or.gov permitcenter @springfield-or.gov PROJECT STATUS: Issued ISSUED: 09/25/2013 EXPIRES: 03/24/2014 STATUS DATE: 09/25/2013 APPLIED: 09/20/2013 SITE ADDRESS: 960 16TH ST,Springfield,OR 97477 SCOPE: Electrical Only • ASSESOR'S PARCEL NO: 1703362204603 TYPE OF STRUCTURE: Commercial PROJECT DESCRIPTION: EL-Tenant improvement to basement floor OWNER: MCKENZIE MEDICAL LLC Phone Number: ADDRESS: 541 WILLAMETTE ST STE 109 EUGENE OR 97401 L 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 MEILI CONSTRUCTION CO CCB 63771 01/20/2014 541-485-1417 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 nplw^"` ATTENTIQNatOfEfgaa lap requires you to fp Prizes adQpfe I y e Oregon Utility .•N'of figga� •od-Clenter. f Dies are set forth NOTICE: "```-°- in A1f952-001-001 hr ugh OAR 952-001- THIS PERMIT SHALL EXPIRE IF THE WORK 0090. You may obtai copies of the rules by AUTHORIZED UNDER THIS PERMIT IS NOT calling the center. (Note: the telephone number for the Oregon Utility Notification COMMENCED OR IS ABANDONED FOR Center is 1-800-332-2344). ANY 180 DAY PERIOD. Springfield Building Permit 9/25/2013 12.53:05PM Page 1 of 1 SPRINGFIELD CITY OF SPRINGFIELD -� + TRANSACTION RECEIPT 225 Fifth St Springreld,OR 97477 _?..•\ 0 REGON 541-726-3753 O 811-SPR2013-02121 www.springfield-or.gov 960 16TH ST permitcenter@springfield-orgov RECEIPT NO: 2013002136 RECORD NO:811-SPR2013-02121 DATE:09/25/2013 DESCRIPTION-__._� -_ACCOUNT_CODE/TRANS.;CODE "• AMOUNT DUE Branch circuits with service or feeder each circuit 224-00000-426102 1004 130.00 Services 200 amps or less 224-00000-426102 1004 89.00 State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 26.28 Technology fee (5%of permit total) 100-00000-425605 2099 10.95 TOTAL DUE: 256.23 4 PAYMENT TYPE PAYOR CASHIER:JLARSON r :COMMENTS . -`' AMOUNT PAID _4 Credit Card JK GUCKENBERGER ELECTRIC INC 256.23 055726 TOTAL PAID: 256.23 • • Electrical Permit Application ( DEPARTMENT USE ONLY 1. _ "' a cloww(e{4 g t1A4tVEts r n. k'fy"1 g SPRINGFIELD PI e Vet ye PRINGF' .'':44 i 'k - !P��, " e/ 3 oz( .-\_. 7 `tAtta tttit 'KCaew 'sn3 -Ssn'4' r Al", ` Pcnnil no.:.e// COI 225 Filth Shill♦Sp,u0,Md.OR )7477♦P11(s 1)726-3753+I t\(541)726-3689 ... ' OREGON Date: ' 2 5-I/ 5 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. _ LOCAL GOVERNMENT APPROVAL FEE SCHEDULE Zoning approval verified? ❑ Yes ❑ No Number of inspections per item() Qlp. Cost TOli1l CATEGORY OF CONSTRUCTION cost ---- Residential,per unit,service included: ❑ Residential ❑Government ❑Commercial JOB SITE INFORMATION AND LOCATION 000 q. e.or less(4) $147.50 £ Each additional 500 sq. Il.or portion Job site address: 1760 /6 14. thereof —_-•-$ 27.50 $ --- Cih -___-1 Cff'/ Slate: p/c ZIP: Limited energy(2) $ 35.00 5 Reference: Taxlot,: Each manufactured home or modular 5 69.00 I D OF WORK dwelling service or feeder(2) I Services or feeders:insfallaiimt niterniion,relocntion rx- _ lG a 200 amps or less(2) 1 S 89.00 4— PROPERTY OWNER 201 to 400 amps(2) $ 104.50 $ I Name: �n� / / 401 in 600 amps(2) $174.00 $ Address: g4/4.-_,y/ (,/i/4.y€/fe 576-- - /�' 601wIA00 amps(2) $225.50 $ City: y State: c:;< ZIP: Over 1,000 amps or volts(2) $516.00 $ • Phone --- Pas: - - Reconnect only(2) S 69.00 $ ---- E-mail: Temporary services or feeders: histc a rion. ulreralion,relocation This installation is being made on residential or farm property 20)amps or less(2) $ 69.00 $ owned by me or a member of my immediate family. This 21)1 to 400 amps(2) $ 96.00 S propery is not intended for sale,exchange, lease,or rent.OAR —-- 479.540(I)and 479.560(1). 401 to 600 amps(2) 5138.50 S 1 Sianalurel Over 600 amps or 1.000 volts.see services or feeders section above 1 CONTRACTOR ,�,INSTALLATION Branch circuits: Crew. alteration.erten.sion per panel I Business name: 3 K 6, 65.0c...4-Inc)c) ein( _ a. Fee For branch circuits with purchase of a service or feeder fee: Address: a 161 ,-1!O_� �>L Each branch circuit '� $ 6.50 $ Ci[}-: )-Q kiNtale: (/ ZIPC�'7�'� b. Fee for branch circuits without purchase of a service or feeder leee: Phone: S�( - '1 -Lk, i Fa,x:9(J( -7 e—MS.5 _ First branch circuit(2) S 60.50 5 E-mail: y 6 Ca) 3K(o EL.LJC-.COD Each additional branch circuit S 6.50 5_---_- Miscellareous fees:rewire or feeder not included __ license no.,, ____ Z� BCD license no.: LO-21)L Sinning supervisor's license no.: 4$1 S Each pump or irrigation circle(2) S 69.00 S _— 5__ N mi name of si nog super visot_t fix 1(.P�,� .� Each sign or outline lighting(2) _ __ S 69.00 $ i S i g n a I circuit or a liriled-energy panel. $ 80,00 $ _._= Supervisor: aheratian.or extension(2) Signature of signing s Each additional inspection:(I I $80.00 $ APPLICANT USE (A) Enter subtotal of above liras (Minimum Permit Fee 580.00) (B)Enter 12%surcharge(.12 x IA)) S (C)Technology Fee(5%of[Al) S 440-2584d N'01120131CONl TOTAL fees and surcharges(A through C): $L%