HomeMy WebLinkAboutPermit Electrical 2009-9-30
FROM ...JKQ EI ectr- ic Inc.'
<WED)SEP 30 2008 ~0:SO/ST.~0:50/Ho.7500000000 P
DEPARTMENT USE ONL Y
,
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~lectricalPermit Application
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0.5 Fifth Sttftt.Sprt"Cftdd., OR ,..,-477. P1f(541)7Z6-37Sl.F;\...X(SoII )71'-J689
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This permit b iUUt:d under OAR 9,18-.)09-0000. Pennib.re. nontrandeBbIe.. Permi'~ CJ.piR il.ork it not started 'Wilhb1180
d.y. or~su'ncc or if work iA sullpmdd.for 188 U,...
LOCAL GOVERNMENT APPROVAL \ \ FEE SCHEDULE
ZoningupprOYDlveriftcd? Q] Yes ONo _1 I N..niberoriR.lpedionsperilem() !Qt)..\ <=::t
CATEGORY OF CONSTRUCTION ~
L 1 t Raidrntial, prr unit, :wrvict! included:
o Rcsidcntiiil o Gmil."TIurienl r'RCmnrn~ciCll
,JOB SITE INFORMATION AND LOCATION i I,OOO'q, [l.m\o",(4)
. \'- t j I Each addiliwal'500 sq. n. or portiun
. Job sile .ddress: , ,-+[0 D 0 " S lhere<>(
Ci.y ~Vi~I.R.ld I Stalc:OV I ZrP:CH"-'i7 \ I Limited""agy(2)
. SubdiYisi~n: -....... l Lot nO.: 1 Ea-.;h manufacl1,m:d home or mudu\ar
UI:5CRlPTION OF WORK 1, dwclline senn~,.,;, (eede' (2) , $ 63,00 $
Ad(;\, i C'\,CI r ((( ('.W:+c.. '3 ~ \ i fY\!-k>r;i t'1'l!'ffiU 11 I Servi"",.. r.......' in,'olloIiO", oll.rallo", "daeolla,"
\ j . :J --J I 200 amps or lc~s (2) $ 81.00 $
PROPERTY10WNER 1j I 20110 400 amp' (2) $ 95.00 $
\ Name: I 40110600 .mps (2) $158.00 $
I Address: I I 60 1'0 1.000 amps (2) S_,OO $
City: I SUle: I ZIP: 1 \ Ov',' 1,000 amps 0' voUs(2) $469.00 ~
Phone: I Fax: I Reconnect only (2) S 83.00 S
I E-mail: 1IT.inP......).serv;.....0.r.........in.lallalinu. oJlemllo", "daeollo"
This installation is being mod.e on:-re~idenualor farm property 1 200 amY" OJ 'c:i:i (2) S faa.DO S
owncdby~co[amembcrofmy immcdialetamily. This 1201 tCl4UOamps(2) S 87.00 S
property is.nol inlended for sale, exchange, lease. or rent. OAR'
479540(1) and 479.560(1), 1401,a600.mps(2) S126.00 S
SignalUre: lOver 600 amps 0' \,000 Volls, sO< services ar reed." "",'ion .bove \
1 M n ~QtffAACTOR INSTALLA nON I Bunch d,aa'" ....... nll.ratinn, exJmsion per "".../ 1
Il3usin.~;~;"~iL~ ,.' 'G-fWd-Li ~ffiI .. Fe< [or brunch cireui'" wifh pu,ch."" af. se",ice", [eede, ree: ~
I ,....... ...' .-:;.. I r\L :L,\f rllt"lr H 0 t\ I '
AiliIrcs!:IITZ,.lf5nE:n " I RH=l,' ~"D'_":r In t,n_~ ~achb....chci..t.nENTION: OrellOnI13V$r's:.Odil19~Y?~,t..
I t;:.r;,>~;";;..:r; ds.4!t~:;G;...f'I,vTlldlAb!.Jf:71 IbF f b htr'.""-'~lr,c'U{"";..-Irll'~I""I'r;Y"l"',''''''fc::edll'fiJ'l\Jil
City: [,...;,&i',,~-.'lJ~' _. ~~,~ ~~€kc f~)~.f--M- ' ce 0.- runCt~~~1~':::!:;,~~~::se:t~~;:~';T~~Mn~oF+~""h
I Phane:A~i';/."'...R\.;;~, Fax:'5tH -1Lib~o ~ _ Hr.<< bruneh ei!1i'\i\(i',), q<;?-nn1 :nn]1 rI thl n~(~~'fl9)I::lSJE~S'O .1-
I [-moll '"1j:',(4) .jt<.U::~ L01'V1 . , Each oddili'"'l\l,!>[a~Fh,!:i"",;t\ay Obi ai;r,c JfSge.oo j liS r\I'!.i,4>y
I CCIl hc.n"" no.. 451 Z.'1 l BCD license no.: zO.2..nC,. I Mi>afI......... r...9~~\'v'la, \JT'i'e'~lfJi'inill~~:.~,ne ,1~IEJp'noneJ
I .1 I ~..nb . .lltlllIUt11 IV' lilt::' V.t:<\:IUlIl ',.J~I"~W ''\lI~''''''''''''lIV'I'
SI19llng SUp'-TVlWr's license no I .. ""'f'1l'1'S.s I <;.ia.pump Of"lmsatJOfl c,i-C1~...J.f)...". it"' ' _~HV _r.:'::!~,.Mt1 1)$
~~.I'Jmme nf signing SUpcrviSO',',__WWO L{ btY V n ~~ IOAch '"Il" a~ ""t1ine lighliog(Wn - -.$ 63,00 's I
d Sig""'",c"nf signing supervisor~ ~ -. J I ~'~:i:~o:.'e~I;:::tz)enc'.,. panel, ~ $ Q3.0ll S, ~Io 1
, c.........; I Eocb additional in'J""<d"", (I) S5II.00 $ 1
~ I APPUCANT USE \
(\~ \0.. . ,'0 \ (A) Enler ...btoraJ or .bovet'ec. $ -1-.
\) ~ (!\-1inimum PcnnitFeoeS58.(0) )(~
~ ' I (Il) En,.,. 12% ...,eh'f};. (.12 -[All $ 1
I (C) Tc:ehm,\l,"'SY Fc.c (&'/.. of lAD $
I TOTAL roes and surch.'Il" (A lhrougl1 C): S, 5'l5 .c:i1?"
Tolal
cod
S134.oo
s
S 25,00
s
$ 32.00
$
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CITY OF SPRINGFIELD
Building/Combination Permit
Status
OK to Issue
PERMIT NO: COM2009-01162
ISSUED:
APPLIED:
EXPIRES:
VALUE:
08/11/2009
03/3012010
$ 85,000.00
225 Fifth Street, Springfield; OR
541-726-3753 Phone.
541-726-3676 Fax.
541-726-3769 Inspection Line.
J
SITE ADDRESS: 1460 G ST
ASSESSOR'S PARCEL NO.: 1703362204601
Springfield TYPE OF WORK: Interior
, . TYPE OF USE: Alteration
PROJECT DESCRIPTION, Intedor Alterations, Med. Gas, Exterior 1,500 gallon Liqnid Oxygen Tank
Commercial
Owner:
Addres~:
Mc'IffiNZIE WILLAMETTE REGIONAL MEDICA
. PO BOX 190700
SAN FRANCISCO CA 94119
Phone Number:
541-726-4432
Contractor Type.
Architect
. General
Electrical
Fire Contractor'
Low Voltage Electrical
Plumbing
I CONTRACTOR INFORMATION I
Cqntractor License
GERALD MCDONNELL AND ASSOCIATES
MCKENZIE COMMERCIAL CONTRACTOR45539
J K GUCKENBERGER ELECTRIC INC 45129
JND FIRE SPRINKLER, INC
SIEMENS BUILDING TECHNOLOGIES INC 133041
ROBINSON PLUMBING INC 107124
I BUILDING INFORMATION I
#ofUni&!OTlGE: # of Stories:
PrimaryT@~&.FaiPc.ylGr&tlM:LL EXPIR!7IF THE wCffmht of Structure
Secondal\YJ~C'Dpli!ifaJCliJr9!!i!R THIS PERMIT IS Ntrre of Heat:
Primal1OC<i!1$t!I!~~l!'!.1DT~PI'IS ABANMNED FOR' Water Type:
Second'IQ'JV:'?lftr\'1'Af'P!rfftlD ~ Range Type:
# of Bedrooms: . Energy Path:
Sprinkled Building:
Expiration Date
07/2112011
04/24/2010
Phone
541-344-9157
541-343-7143
541.746-3855
541-686-1964
847-215-1000
541-345-6909
01106/2011
07113/2011
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
Yes
Frontyard Setback: i'
Side 1 Setback: J -
Side 2 Setback:'
Rearyard Setback:
Solar Setbacks:
I DEVELOPMENT INFO~MA !I~N. -::Jre on law reouires V, ou to
... . -... - 9 REQUIRED PARKING
, follow rules adopted by the C'o!;"" v"".\ .
Overlay Dist: Notification Center. Those rulLTo'ilif:set forth
. 0010 th gh ~ Hi (l~?-()()j-
# Street Trees Rq!l:)AR 952-001- rou Hanlhcapped:
, bt' p'es -"h" ""~s oy
Paved Drive Rqd,090. You may 0 am co I €ompact:.
% of Lot Coverage:alling the center. (I~ote: the tel~~none
number for the Oregon Utility Notification
r.on'''' i" 1-800-332-2344).
I PUBLIC IMPROVEMENTS I
Street hnprovements:
Storm Sewer Available:
Special Instruction:
Sidewalk Type:
Downspouts/Drains:
Notes:
Pa~e I of5
-~!';.~el,,w~~(;r10'
11_. ",,' -
. \"J '"..', '
,1, '
CITY OF SPRINGFIELD
Building/Combination Permit
. Status
OK to Iss!le
PERMIT NO: COM2009-01162
ISSUED:
APPLIED:
.EXPIRES:
VALUE:
08/11f2009
03/30/2010
$ 85,000.00
225 Fifth Street,"Springfield, OR '
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
I Valuation Description ,
Description ' . Tvpe of Construction'
Estimate Estimate
$ Per Sq Ft
or multiplier
$1.00
Square Footage
or Bid Amount
126,000.00
Value
Date Calculated
Total Value of Project
$126,000.00
$126,000.00
08/11/2009
lJ~P~' tiW
Fee Description
Plan Review Comm/IndlPublic
+ 12% State Surcbarge
+ 5% Technology Fee
Add, Alter, Extend Circ ,.
Add, Alter, Extend Circ Ea"Add
Traffic' Signal - Panel
Amount Paid
Date Paid
Receipt Number
$529.47
$38.28
$15.95
$55.00
$138,00
$126.00
8/11!09
9/30/09
9/30/09
9/30/09
9/30/09
9/30/09
1200900000000000899
1200900000000001107
1200900000000001107
, 1200900000000001107
1200900000000001107
1200900000000001107
. Total Amount P id
$902.70
I Plan Reviews I
Structural Review 08/12/2009
Initial Review 08/12/2009 08/12/2009 APP 1.1.8
Structural Review 08/19/2009 08/19/2009 10 KLK Started 1st review.
Structural Review 08/25/2009 08/25/2009 WI KLK Completed 1st Review. Checking
Fire and Med, Gas.
SUB Review 08/12/2009 08/28/2009 APP JF Energy forms sent to SUB with
plans/llh
'.;
Paee 2 of 5
CITY OF SPRINGFIELD
Building/Combination Permit
Status OK to Issue PERMIT NO: COM2009-01162
225 Fifth Street, Springfield, OR ISSUED:
APPLIED: 08/11/2009
541-726-3753 Phone EXPIRES: 03/30/2010
541-726-3676 Fax
541-726-37691nspection Line. VALUE: $ 85,000.00
Medical Cas Plan Review 09/01/2009 09/03/2009 WE SKC 1.Please provide an engineered plan
detail of the bulk oxygen system
'. located on plan sheet M-I00. In the
detail please include the liq uid tank,
seismic anchoring, reserve tank or
cylinders, manifolds, and
equipment. 2.Provide a copy ofthe
manufacturers installation standard
for the Hyperbaric Chambers.
3.Provide engineered calculations
for siziug the bulk oxygen supply
system, including reserve supply,
and medical gas piping serving
Hyperbaric Chambers all shown on
plan sheets M-IOO & M-lll.
Public Works Review 08/12/2009 09/10/2009 DON CTM
Fire Department Review 081I2/2009 09/14/2009 WE CRC Need info on cryo oxygen tanks,
vaporizers, piping, connections, etc.
See attached document for Fire
Department Plans Review
comments.
Plan nine Review 08/12/2009 09/15/2009 APP 'EMM See notes on plan regarding
screening requirements for exterior
oxygen tank enclosure. Copy of the
site plan with changes have been
added to Final Site Plan Equivalenc)
Map file for the hospital.
Structural Review 09/16/2009 09/16/2009 10 KLK Received HY AC Energy Forms:
Forwarded Copy to SUB.
Structural Review 09/24/2009 09/24/2009 IO KLK Received Submittal response to Ist
Review from Architect, 9122/09.
Routed response for Fire and Med
Cas.
Structural Review , 09/25/2009 09/25/2009 WI KLK Waiting Completion of Fire and
Med. Cas Review
Paee 3 of 5
.......NItlI"'''''''..' ,
--~fJ0~0'*",,+~~J\,'
, ~~',~"\' ~:'!,.' ,~ui'1}?~1
Status
OK to Issue
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax .
541-726-3769 Inspection Line
Fire DeDartmen't Review
Medical Gas Plan Review
Structural Review
09/28/2009
09/29/2009
09/3012009
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-01162
ISSUED:
APPLIED:
EXPIRES:
VALUE:
08/11/2009
03/30/2010
$ 85,000.00
Addendum to Plans Review dated
9/14/09. Job #COM2009-01162.
Supplemental plans provided for
cryogenic oxygen tank and
hyperbaric chamber. Supplemental
plans for cryogenic oxygen tank
showed locations of signage Doted in
earlier plans review. Supplemental
plans for hyperbaric chamber
reviewed under NFPA 99, Health
Care Facilities, Chapter
20-Hyperbaric Facilities, 2002
edition.
09/2812009
APP GRG
09/29/2009
Provide signs on doors leading to
wound care/hyperbaric room
stating, "CAUTION Medical Gases
NO Smoking or Open Flame"
(NFPA 99 and 99C, 5.1.3.1.6).
Provide listed 1 hour rated lockable
gas cabinets for storage of the
compressed air cylinders or doors
entering to the wound
care/hyperbaric room shall be
capable of being secured and locked
(NFPA 99 and 99C, 5.1.3.3.2, #2 and
#4)
Notes 1 & 2 added to approved plan
sheet M501 details 4 & 5. Note 1 -
Provide signage: "Caution: Medical
Gases No Smoking or Open Flame"
(NFPA 20.2.9,2.4) Note 2 - Provide
labeling: "02 70-90psi" (NFPA
5.1.11.3.2)
APP SKG
09/30/2009
APP KLK
To Request an inspection call the 24 hour recording at 726-3769. All inspections requested before 7:00
a.m. will be made the same working day, inspections requested after 7:00 a.m. will be made the following
work day.
UeolliredJ.l1.~nections I
Site Inspection: To be made after excavation but prior to setting forms.
Ufer Electrical Ground: Install ground rod at footing and call for inspection in conjunction with footing and/or
foundation inspection.
Page 4 of5
CITY OF SPRINGFIELD
Building/Combination Permit
Status
OK to Issue
PERMIT NO: COM2009-01162
ISSUED:
APPLIED:
EXPIRES:
VALUE:
08/11/2009
03/30/2010
$ 85,000.00
225 Fifth Streeti SprIngfield, OR .
541-726-3753 Phone
. 541-726-3676 Fax
541-726-3769 Inspe~tion Li~e
Footing: After trenches are excavated.
Foundation: After forms are erected,but prior to concrete placement.'
Slab: To be made after all ins lab building service equipment, conduit piping and other equipment items are in
place butprior to concrete. "
Framing Inspection: Prior to cover and after all rough in inspections have been approved,
. I; ,
Wall Insulation: Pri~r to cover.
Drywall: Prior to taping.
,
Epoxy Anchors: To "be done by Certified Spcial Inspector. Provide Inspection results to City Building Inspector.
Fire Department Sp~inkler System: Prior to cover. Hydro pressure test, fire line flow test.
I,
Fire Department Ahirm System: Fire Department Alarm System Acceptance Inspection. This inspection must be
requested and appro:ved prior to requesting any occupancy approval.
Final Fire Department. After all requirements of the Fire Department have been met.
Final Building: Afte:r all required inspections have been requested and approved and the building is complete.
Rough Plumbing: Prior to cover and including required testing.
Final Plumbing: Wilen all plumbing work is complete.
Underground Medical Gas: Prior to cover and including required testing.
Rough Medical Gas:i Prior to cover and including required testing.
Final Medical Gas: When all medical gas work is complete and certificate is provided to inspector from verifier.
Rough Gas: After Ii~e is installed and required testing and capped if not attached to an appliance.
Rough Mechanical: Prior to Cover
Final Gas: When all"gas work is complete.
,
Final Mechanical: \\Ihen all mechanical work is complete.
Underslab Plumbing: Prior to filling the trench and including required testing.
Rough Electric: Prior to Cover
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 of 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 c~ntractors 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 tlie site at all
times during construction.'
\f1'C, fCU. l{Q C//3JI()Q
Owner or Contractors Signature
Date
Page Sot'S
. ..
;;'
225 Fifth Street-.,: .
Sp'ringfield, Or~g~~,97477
541~726-3759PIio'iie" .
Job/JournalNumber
COM2009-01162
C0M2009-01162.
C0M2009-.o1162
CQM2009-,o1162
COM2009,01162
Payments:
Type of Payment
CreditCard
cReceintl
RECEIPT #:
1200900000000001107
. Description .
".Add, Alter,'Exiend Cire
. , - , ." .; .~- .' . .'.~,:
'.;Add,"Alter, Extend Cire Ea Add
" i:' "TraffieSignal - Panel
"1'!', ".
,if ,,'),;+ ~%Teehnology Fee
'~"i;+i2% 'State"Sl!feh';'ge
Paid By ..
JEFF~s:.1 ?USK.~NBERGER
L:heck Number
Batch Number
Received By
KR
"
Page 1 of I
City of Springfield Official Receipt
Development Services Department
Public Works Department
Date: 09/3012009
Item Total:
Authorization
Number How Received
04510D Fax
Payment Total:
1l:42:17AM
Amount Due
55.00
138,00
126,00
15.95
38,28
$373.23
Amount Paid
$373,23
$373.23
9/3012009