HomeMy WebLinkAboutPermit Electrical 2010-3-3
Electricai' Permit Al!plication
It'Gl~~I~ml~i~~'
225 Fifth S(J'ft't.Sp~ld, OR 974'7.PH(541)726-3753-+ FA.X(5-tt)726-3689
~~~
~
~
,D!OPARTMENT USE,ONLY,
COw<ZOIO -002
Permit no.:
Date 3-3-10
This permit is issued under OAR 9J8-309-0000. Pcnnit.~ are nontranderable. Penllits expire if work "not started within 180
days ofissuan<< or if work is suspended for 180 days-
This installation is being made on residemial or farm property 200 amps or less (2) $ 63.00 $
owned bv me or a member ofnw immediate lamiI\'. This 201 to 400 amps (2) S
property'is not intended for sale: exchange, lease, or rent. OAR $ 81,00
479540(1) and 479,560(1), 401 10 600 amps (2) $126.00 $
Signature: Over 600 amps or 1,000 volts. see services or feeders seCtion above
..' CONTRACTOR INSTALLATION.- ..,' Branch drcui": """, ai/em/lOn, cX1e1lSl0nperpanel
...__ W, L'"' '~"'u":or~-~-"_~M"_~
Address 2..1'51 1Jc,(\ <>J..y U ~ Meation Cent:' '~ I /L1WQl1c1.11i1ity ! $ 6,001 $
CIty' C ^ rr 0 (A I State. 0' ''Jfl>9~fll1r-Po 0 Hrdlffi-fr ,thoul purchase ofa se[V'ce 0/ feeder fcc,
Phone ~l :1<.1'=>./';'" TFax,:><Hc . lnco~~~~ / $ 55,00 $ 55
E-mnrl' --;;>P.~0t<"..e:t~~.c...oM number lor the Or J ~horaehcm:U1t 3. $ 6.00 $ 18
CCJ3hcenS::no 4'51l..<1 I BCDhcenseno 2.8@2!flii! 1 ~. ceorfeederno/mcluded
Signing supervisor's license no.: L.t-1l'~..s j Each pump or inigation cirole (2) S 63.00
Print~eofsigning:iupcrvisor;< \tJt..,." 11 Wy1' J If' EachsiguoToutlinelighting(2) $ 63.00
Sio.rmture of signing supervisor: I Signal circuit or a limited-coeTgy panel, , $ 63 00 $ b"
e alteration;or extension (2) ..)
v
~~~
~'vV t<.~.
NOTIC!:: ~y\'J~l'Il?!'I!!~.I'~ (5% oflA\)
THIS PERMIT SHAll EX 1~~~~rJ(es (A through C):
AUTHORIZED UNDER THIS PERMIT IS NOT,
COMMENCED OR IS ABANDONED FOR .., ,
ANY 180 DAY PERIOD.
: ". ',LOCAL GOVERNMENT,.AJ>PROVAL' -',,;;'
Zoning apptoval veritied? 0 y cs 0 No
" . ''''',' "CATEGORY Of CONSTRUCTION' ,',
o Residential I 0 Government LEtconmlt~rcia]
::" JOB SITE INFORMATION,AND',LOCATlON:
Job site address: I 'f b 0 & s:. t-
City: <.? F 'b - I State:o(L ZIP:'? 7'177
Subdivision:f70]3b Z2 I Lot no,: Qt,tb6 (
" ,DESCRIPTION OF .WORK " ',,, ,
Q:e-;'(Oll'\-;~ O~- -, ,
PROPERTY OWNER". :,.' .'.
Name i')1 Cl.C.t:rde/lC W ILLAlM~rtr WL
Address:?6 I:it'x / '70 70 C:> .
City:$Av' F(-,4AC.ISCC I State cA ZIP: 'i'l/Iq
I Fax: - ,
Phone:
E-mail:
440.2584.J (9/08iCOf\I)
':~: 'FEE,SCHEDULE.
, ". , ",
Cost 'Total
elL ' cost
$134.00 $
$ 25.00 $
$ 32.00 $
$ 63,00 $
. --~- ,,-
Number ~finspectionsper ite;n f)...-. Qlj'. .
" - - .< '~'-, " . - '. ,-
Resid~ntial, per unit, Sf'rvice included:
1.000 sq. ft. OT 1~ (4)
Each additional 500 sq. ft. or portion
!hereof
Limited energy (2)
Each manufactured home or moduhlT
dwel1ing service or feeder (2)
Sen'ices or feeders: jus/alia/ion. alteratioll. relocation
200 amps or less (2) $ 81,00 $
201 to 400 amps (2) $ 95,00 $
401 to 600 amps (2) $158,00 $
60 I to 1,000 amps (2) $205.00 $
O,:er 1.000 amps or volts (2) $469,00 $
Reconnect only (2) $ 63,00 $
Temporary services or feeders: ins/al/alion. alteration, relocation
$
$
Each additional UtspKtion: (I)
", , ".',' ,APPLICANT, USE
$58,00
$
", "
(A) Enter subtotal of above fees
(!\linimum Permit Fee S58.00)
$JSb
$ /b'n
$ bBO
$/ S 9 I ~
(~2.~tcr 12% surcharge (.12 x [AD
,
~.::Y ~
/}j~ ~
~L? $'
Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM20I0-00268
ISSUED: 03/03/2010
APPLIED: 03/03/2010
EXPIRES: 09/03/2010
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753' Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 1460 G ST
ASSESSOR'S PARCEL NO.: 1703362204601
. Springfield TYPE OF WORK: Commercial Miscellaneous
TYPE OF VSE: Alteration,
Commercial
PROJECT DESCRIPTION: Renovate operating room 7
Owner: MCKENZIE WILLAMETTE REGIONAL MEDICA
Address: PO BOX 190700
SAN FRANCISCO CA 94119
I CONTRACTOR INFORMATION ~
Contractor Type
Electrical
Contractor License
J K GVCKENBERGER ELECTRIC INC 45129
I BUILDING INFORMATION R
Expiration Date
0412412010
Phone
541-746-4656
# of Vnits:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
# of Stories:
ATTENll!eiglitG)f~rudQrerequires you to
follow rq'ype<lJlil~ by the Oregon Utility
Notificatiwafe"rttype:rhose rules are set torth
in OAR 9R~~1~W through OAR 952-001.
0090, y~~ ~\4\ifl copies of the rules by
dallingsl1(i\~lPbu{flIlll~; the telePlMlne
number fOr the Oreoo" tilitv Nntlfi~tJnn
I DEVEE5~E!M1lQjI~M~ ~
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
REQUIRED PARKING
Front yard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
TotaI:
Handicapped:
Compact:
Street Improvements:
Storm Sewer Available:
Special Instruction:
I PUBLIC IMPROVEMENTS ~
"
Notes:
Sidewalk Type:
. . . . ."....-;"""i..Downspouts!Drains:
NOTICE' '. "'-"',c",',
THIS PERMIT SHALL EXPIRE IF THE WORK
AUTHORIZED UNDER THIS PERMIT IS NOT .
FOR .
1~ alH~tPo~Y 8~s~l~giion ~
Description
Type of Construction
$ Per Sq'Ft
or multiplier ".
'.
S'ILlare Footage
or Bid AmoLlnt
Value
Date Calculated
,
Pa2e 1 of 2
Status. Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2010-00268
ISSUED: 03/03/2010
APPLIED: 03/03/2010
EXPIRES: 09/03/2010
VALUE:
Total Value of Project
F ~es Pai<ll
.: I ~
Fee Description
+ 12% State Surcharge
+ 5% Technology Fee
Add, Alter, Extend Circ
Add, Alter, Extend Circ Ea Add
Traffic Signal - Panel
Amount Paid
,... ~
Date Paid
$16.32
$6.80
$55.00
$18.00
$63.00
3/3/10
3/3/10
3/3/10
3/3/10
3/3/10
Receipt Number
220ioOOOOOOOOOOOl88
2201000000000000188
2201000000000000188
2201000000000000188
2201000000000000188
Total Amount Paid
$159.12
1 Plan Reviews ~
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.
LReouired InsDections ~
Rough Electric: Prior to Cover
Low Voltage: Prior to cover.
Final Electric: When all electrical work is complete.
<OJ'
,.
~'" .
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
th:lt NO OCCUPANCY will be m:lde of :lny structure without permission of the Community Services Division, Building Safety.
I further ccrtify that only contr:lctors and employees who lII'e.in compliance with ORS 701.005 will be used on this project.
I further :lgree to ensnre that all reqnired inspections are requested afthe proper time, th:lt each address is re:ldable from the
street, that the permit card is loc:lted :It the front of the property, and the approved set of plans will remain on the site at all
times during construction.
Owner or Contractors Signature
Date
'..
, ,
; Pace 2 of 2
1'-'
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
8~.'j: ~F1._.IlLO....:...
Wir.. .
. j
.
.. ,h..'.__"."..~..~.." <-... -.-
City of Springfield Official Receipt
Development Services Department
Public Works Department
RECEIPT #:
2201000000000000188
Date: 03/03/2010
9:20:19AM
Job/Journal Number
COM20 I 0-00268
COM20 I 0-00268
COM20 10-00268
COM20 1 0-00268
COM20 I 0-00268
Payments:
Type of Payment
CreditCard
cReceint 1
Description
Add, Alter, Extend Circ
Add, Alter, Extend Circ Ea Add
Traffic Signal - Panel
+ 12% State Surcharge
+ 5% Technology Fee
raid By
JEFFREY GUCKENBERGER
Check Number
Received By' Batch Number
djb
. '.;('i\ H,
~ I ; l
Page I of I
Item Total:
Authorization
Number
Amount Due
55.00
18.00
63.00
16.32
6.80
$159.12
How Received
Amount Paid
o 1599d In Person
Payment Total:
$159.12
$159.12
3/3/20 I 0