HomeMy WebLinkAboutPermit Electrical 2014-3-4 SPRINGFIELD
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CITY OF SPRINGFIELD Springfield,OR 97477
-_', 1 225 Fifth St
Phone: 541-726-3753
'.% -- OREGON Building / Commercial Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2014-00472
www.springfield-or.gov permitcenter @springfield-or.gov
PROJECT STATUS: Issued ISSUED: 03/04/2014 EXPIRES: 08/31/2014
STATUS DATE: 03104/2014 APPLIED: 03/04/2014
SITE ADDRESS: 1040 GATEWAY LOOP,Springfield, OR 97477 SCOPE: Electrical Only
ASSESOR'S PARCEL NO: 1703222002402 TYPE OF STRUCTURE: Commercial ,
PROJECT DESCRIPTION: Dental Office Renovation .
OWNER: NECA-OREGON-PACIFIC-CASCADE CHAPTER Phone Number:
ADDRESS: 1040 GATEWAY LOOP STE A
SPRINGFIELD OR 97477
• 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
LINSPECTIONS REQUIRED
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Inspections .
4220 Electrical Service Electric Service: Approval required prior to utility company energizing service.
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.
1 j,.w
Owner or Contractor Signature 11 Date
ATTENTION: Oregon IS requires you to
follow rules adopted by the Oregon Utility
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Notification Center. Those r h OAR 952-001- NOTICE:
in OAR 952-001-0010 throng THIS PERMIT SHALL EXPIRE IF THE WORK
ndi90. You may obtain copies of the rules by
• ,-.,4,no 'the center. (Note: the telephone AUTHORIZED UNDER THIS PERMIT IS NOT
- -r ;or the Oregon Utility Notification COMMENCED OR IS ABANDONED FOR
' (_t,nIs.r is 1.800-332-2344). ANY 180 DAY PERIOD.
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Springfield Building Permit 3/4/2014 12:45.55PM Page 1 of 1
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• SPRINGFIELD CITY OF SPRINGFIELD s1.f 225 Fifth St
L TRANSACTION RECEIPT Springheld,OR97477
OREGON 541-726-3753
811-SPR2014-00472
www.springfeld-or.gov 1040 GATEWAY LOOP permitcenter @springfield-or.gov
RECEIPT NO: 2014000484 RECORD NO: 811-SPR2014-00472 DATE: 03/04/2014
!DESCRIPTION- ` t - ACCOUNT CODE-it-TRANS CODE AMOUNT DUE
Branch circuits with service or feeder each circuit 224-00000-426102 1004 234.00
Services 200 amps or less. 224-00000-426102 1004 89.00
State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 38.76
Technology fee (5%of permit total) 100-00000-425605 2099 16.15
TOTAL DUE: 377.91
! PAYMENT TYPE PAYOR CASHIER:JLARSON „, . ':COMMENTS - ' • AMOUNT PAID •
Credit Card JK GUCKENBERGER ELECTRIC INC 377.91
055506
TOTAL PAID: 377.91
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FROM JKG El octric Inc. CT UE>MAR 4 2014 9: 17/ST. 9: 17.011.7..E00000030 P l
-" •�•• �,••, •_",: P"' 1 "r ti'/•V I IIUp.IIWWW.UI.spll'ism clu.ln.ustusu/Ut 1U111b LlUlalyl Glcct Will 1-1.:1 WILL...
Electrical Permit Application [ DEPARTMENT USE ONLY
s -' SVRINGFIEID
CITY QE SPRINGFIELD, OREGON z
225 Firth Slrrri+Splulg1eld,OR 97477+PH(5.11)72f 7753.Et\(541)72676K9 .OREGON /
Date: X7/9/ ( c(
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N.,+- 8 eS .S
'lids permit is issued under OAR 918-309-0000. Permits are nontransferable. Permits expire if Ivor' is not started within 180
days of issuance or if work: is suspended fur 180 days.
LOCAL GOVERNMENT APPROVAL _ FEE SCHEDULE _
Luning approval verified? ❑ Yes ❑No Number of inspections per item () Qty. Cost Total
CATEGORY OF CONSTRUCTION _ __ __I__ca, cost
- ._-,_ _..,.___..._`_ Residential,per twit,service included:
❑ Residential 1 ❑ Government ,Commercial
JOB SITE INFORMATION AND LOCATION -1.000sq. R.nrlcss(4) $147.50 $ -
-- r Each additional 500 sq. ti.or portion
Job site address: c hoe. wit-4( I • thereof S 27.50 $
City: 5f Stale: at ZIP: Limited energy(2) -- --_-_ _.S 35.00 -$ - -
' Reference: Taxiut.: Each manufactured home or modular 5 49.00 $
--_'- -._---- _- dwelling service or feeder(2)
DESCRIPTION OF WORK -----
-- -'
-_ _ ..._. ..... .......-.-_ Services or feeders: ird011nlian,OferWliuu,relocation tt r p�m er rte.Nv via oN
200 amps ar less(2
I __ I —_ ) ` $ 69.00 $P pQ i ^
PROPERTY OWNER 201 In 400 naps(2) $ 104.60
- ---------- --------
Name- 401 In 600 amps(2) 5174.00
Address: --_-_-- .-- 601 lu 1,000 mops(2) 5225.50
City: State: TLIP.
Over 1.000 amps or volts(?) $516,00 $
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Phone: - - fax: Reconnect only(2) $ 69.00 $
L-mail: 'Fe mpnriuy services nr Feeders; ina9ollalinn, olrrrnliva. relu[vriun
This id sra liar Ion is beine.made on residential ur faros property 200 amps or less(?) I $ 69.00 S
owned by me or a member of my itrioseliate family. This 201 to 40(1 amps(2) $ 96.00 S
property is not intended for sale,exchange,lease, or rent. OAR ---------- -- ------
479.540(I)and 479.560(1). 401 to 600 amps(2) 5138.50 $
Siguuo , Over 600 Imps or 1.1)11(1 eons,Nee services or feeders section above
CONTRACTOR INSTALLATION Branch circuits:nee alien:rims.exreusfon per panel
Business name: ISLAY-1.L--) a. Fee for branch circuits with purchase of a service Or feeder fee:
Address: 2\<j1 ST Luck branch ckcuk 1._..—T $ 6.50 $
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C:it)' Cii>005 State: ZIP: 4it411 b. Fee for branch circuits svilhoul purchase Ora service or feeder ter:
Phone: Sl4•( - -1(.440,-4ak1 Pa.x:St(.__i q.(p-3g 55 Pirst branch circuit(2) 5 60.50 S
E-mail: rbla J Ks eLL,L•car. ech additional branch circuit 3b $ 6.50 S Z)_`tt.
t5(Z� Miscellaneous fees:service or(eater±U)/ nfef
C C[i license no : BCD license nu.: Z.O •2.a�1 L, ..__ _—
Signing supervisor's license nu.: 14-rel. — S— Each pump or irrigation circle(2) $ 69.00 TS
S
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Punt name oh signing supervisor: r E r Each sign or outline lighting(2) $ 60.00 $
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..._....._.... _....__—_.—.___—.__ 4' Signal circuit o'n limimd-energy panel. $ 80.00 $
Si:mature of siunino supervisor: alga alion,nr cxmnsinn(.) •
Loch additional inspection:(I) $80.00 $
APPLICANT USE
(A) Guar subtotal of above lees $
(Minimum Permit Fee$80.00) 3 Z3
(0)Enter 12%surcharge(.12 x Al)I S
(C)Technology Fee(5%of(Al) S
-- aan-1584 I abut^O UiC'O�l) — —TOTAL fees and surcharges(A through C): $ -8-- -
377
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