HomeMy WebLinkAboutPermit Electrical 2010-7-23
Electrical Permit A
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us Fifth Strftt.Spri~ld, OR 97477.PH(541)726-3753. FA..X(5U)716.36X9
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D~PARTMENT USE ONI..Y
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Permit no.:
D"dte:
.
This permit is issued under OAR 9J8-309-0000. PcrmitN are nontransferable. Pennits expire if work is not started within 180
days o(issuance or if work is suspended for 180 days~
, ,:.:; LOCAl.. GOVERNMENT APPROVAL ,",' " ,"
Zoning approyal yeriticd? 0 Y cs 0 No
",:.C:ATEGORY OF- CONSTRUCTION '
o Residential I 0 Government 1 0 Commercial
JOB SITE, INFORMATION AND LOCATION
Job site address: A. \on (;, S't
City: }')(').o " State:/) Q -- ZlP:l..{ l"'t l
SubdivisiJn: \ V"\ t:>':>~ 1_ fJ n ' 1 Lot no.()t'- t^,)\
,', . DESCRIPTION OF WORK' ','
Ari Ii (\ f'r\ {\ f' (" .t-\ nn '4n \t) ~O
fl. \ \l t - '.1 1- L_..c,..., ~
'PRoPERTY OWNER. .
Name"'(' n""'-'" \ 0'\ \.\ \A-OSP
Address~ [') a....v\C\.b"100
CityC1" 'r:-' r'\ S..te:~
Phone: - - I Fax:
ZIP~\\q
E-mail:
This installation is being made on residential or farm property
o,...ned bv me or a member of mv immediate t~.unil\'. This
property"is not intended for sale: exchange, lease. or rent. OAR
479540(1) and 479560(1).
Signature:
CONTRACTOR'INSTALLATlON " "
Business name: \\0((_ L-I n r..\..v, i ~(,
Address: 2..\"51 ~(\ - ,
City: 'Sn, r( 0 rA I State: DO
Ph0ne: 641 :14"" r. L' I Fax:")tH
I E-mail: --;;>",,(@-j(('=oElyL.un'\'1
CCBlicense no.: 4'512.'1 I BCD license no.: 2.0-2,..1'(.,
Sigrting supervisor's license no.: '-\-'illO;:;S
Prinl name of sigrting supcrvisor:,-Jn./h,-D I ~ hi" 11 JJ n r
-
ZIP: <n4--11
- i4b-~ ~SS'
Signalllre of signing supervisor:
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44{)*2584.J (9i08fCOM)
,', ::, FEE, SCHEDULE:' ','
i~umber~ri~~~~s~r.i~,~'6, . ~ Qt);. .,. ,~t
Residmtial, per unit, SPf"Vice included:
, ,,,',
: Total.
, cost. '.
\.000 sq. ft. or It;SS (4)
r...ach additional 5()() sq. f1. or portion
<hereof
Limited energy (2)
Each manufaculred home or modular
dwelling service or feeder (2)
$134,00 $
$ 25.00 S
S 32.00 $
$ 63,00 $
Services or feeders: installation, a{teraliolJ. relocation
200 amps or less (2) $ 81.00 $
201 t0400amps(2) S 95.00 $
40 I to &10 amps (2) $158.00 S
60110 1.000 amps (2) $205.00 $
(ftcr 1,000 amps or volts (2) $469.00 $
Reconnect only (2) $ 63.00 $
T~mporary services or feeders: installalio11, alteration, relocation
200 amps m less (2)
20110400 amps (2)
401 to 600 amps (2)
$ 63.00 $
S 87.00 S
$126.00 $
Over 600 amps or 1,000 volt'), see services or feeders section abm'e
Braneb circuits: new, alteraJion, extension per panel
a. Fee for bronch circuit.. with purchase ofa service or feeder fee:
Each branch circuit
$ 6.00 $
b, Fee for branch circuits without purchase of a service or feeder fee:
First branch circuil (2)
Each additional branch circuit
\
-
$~5. V
$
$ 55.00
$ 6.00
A-tiscdl3lleous f~: service Qr feeder not included
Each pump or irrigation circle (2) $ 63.00 $
Each sign or outline lighting (2) S 63.00 $
'I
Signal circuit or a limited.energy panel,
alteration. or extension (2)
Each additional inspection: (I)
$58.00 $
t>' .,r.:..... ,.....
$ 53.00 $
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APPLICANT USE
(A) Entel" subtotal of above fees
(Minimum Pennit Fee 558.00)
(B) l-:ntl.."T 12%1 surcharge (.12 x [AD
(C) Technology FGe (5% of lAD
TOTAL fees and snrcharges (A through C):
$
$
$
$
FROM JKG Elec~rlc Inc.
(FRI)JUL 23 20'0 10:Z8/ST.10:28/Ho.7500000487 P
DEPARTMENT USE ONLY
,ledric'al Permit Application
~~.'~~~f.;=$j.t~~'if~*;:.!!.~~-!~~~if~~~~:ff.:>':-~~~~'~~~~~' ,.,'
&1;1 ~t;';~-\~.~ if~;~~~ ~ t~J Pki~~l@ ~ Q. ,~~_&J_ t'!T. ~~ $'
~;..$h~~~~~~~i3&B~~: '..~~~"" . :.
~s Flftb SUn1.SprtBcI'k'W.. OR 77417 .rH(541)71&-)751. FAX(s.tI)n~-3689
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"his ~nnU h i!J&U"d und~r OAR 'J8-J09-0oon. P&:nnib.~ nontranlferabk. Pennit. espire irwork is not IIlarted ,",'ilhin 180
by~ of inLLllftC'C or if 'ft'ork ill IUlIpeaded for 188 day..
-'-
...- LOCAL GOVERNMENT APPROVAL FEE SCHEDULE
(,oning appnwal vcrilicd? DYe. ON., Nu.bcr ofinspc'ctions per linn () Qty. Co.t Total
CATEGORY OF CONSTRUCTION .... 0:001
o Rcsidenli31 I 0 Govenunenl IvrtolWllc=ial Rn;idnltial, pr-r unit, M'l"Viu included:
JOB SITE INFORMATION AND LOCATION 1,000 "I. II. uJl..' (4) S,~.OO ~
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.Iob Slll.:: uddrcss: \%0 G ~ T.c..evf- Each additional ~OO sq. rt_ or portion $ 25.00 ~
thereof
,. .1 Stale:
City: ...rF'U ""'- ZIP: ','117 Limilcd Imergy (2) S 3Z.oo S
Subdivision: I Lot no.: Each manufaclured home or modular ~ 63.00 S
DESCRIPTION OF WORK dwc1lio@.lOCrviceoJ'feeder(2)
"lit.! .. t.",,",IC/!l-+to.v to 10 1AI' )v...u.... ...~o~le~ Sc:rvices 01' feeders: installanoll, a{lf!.rQlion, ,docotfoll
-
..nwv . 200 amps or less (2) S 81.00 $
PROPERTY OWNER 201 10 400 amp' (2) $ 95.00 ~
---"
.... (J,-,td.<tL 40110 600 amp" (2) $158JJO ~
Name: u't<..ll.o<<!1e ~c..u-L
... -..
Address: 601 t., 1,000 amp' (2) $205.00 $
City: I Stale: ZIP: (hrcr 1,000 nmpll: or valls (2) $469.00 $
Phone: - - I Fas: - - Heconnect only (2) $ 83.00 $
ERmail: 'rrmporuy soenica or reeders; installa/ion. aJlemlion, ntfocalimr
....- 200 IlIDlP;" 01' lells (2)
This in!\laBalionis being miJde on residential or farm property $ 63.00 $
o\vncd. by me or a member of my immediate family. This 20 I 10400 amps (2) ~ 81.00 S
property is not inhmded for sale. c~chan8e. lease. or renL OAR 401 10600 amps (:!)
479.540( I) and 479.560( 1). $126.00 $
_h.--
Signature: Over 600 amps \1T 1,000 vollS. see services or feeders section abo\'e
CONTRACTOR INSTALLATION Bunch cirtuit5: new. allerallan. almsion per panel
Business nam~: \ l< L-. L-I f ,r ,7rr\( a. Fcc for brunch "ircuits wlm pnchase ofa 'iCrvice or feeder fee:
AuLlrcss: Z-I<;;, ~n. ~-{ Each bnanch l:ircuit S 6.00 S
City ~~~(Ov1 !S;"teOO 1 ZIP: Q-14.11 b. Fee for branch circui1s wilhout purchase of a service or (ceder fee:
Phone: ~l :1~"- .1. L. I Fax;"\q..j - i%-a ~$ First branch circuil (2) l S 55.00 $ S"S -~
, E-m"il:--;;>?~ ,,,,oc. '-' .(,01Y) ..::ach addilional branch cio:.uit $ 6.00 $
CClllieen:':' nu.: 4512..'1 1 BCD lieeme nn.: 2.0-2..1Ie.. ).tisceOaneous (ea: service or feeder nol included
Signing sup.-TVisor's liCC115l: no.: <4-11 1'5.s Each pump or inigation cj~k (2) ~ 83.00 ~
Prinl name of signiog .upcrvisor:. \AiL,.. I t" y Ji.Jl . I Each sign Qr outline lighling (2) ~ 63.00 $
-". ....,
Signfllurc of sig.ning supervisor: ' - Signal drcuil or a limitcdRC11crgv panel, ~ 63.00 $
wleralioo. or e"..tCllsim (2) .
<::::-J Each ..w;_of u......d...' (I)~ I .jIj8:fIO ~~
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APPUCANT USE.y. k. . -'g., .. ill.$-
(A) EOIer !A.lbtolal of above fees ~ ;;1 iP
(Minimum Pennlt Fcc $58.08)
(8) Enler 12tk mrcha'1!c {.12 x LA]) s/;'W
(C) Ta:.hno\nS}' f'u (S"/.. ",r(A)) ~':z.'i~
TOTAL fees and IUrcharg" (A Ihruugb C); $')[1..~
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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: COM2010-00697
ISSUED: 07/01/2010
APPLIED: 06/0112010
EXPIRES: 0110112011
VALUE: $ 831,944.00
SITE ADDRESS: 1460 G ST
ASSESSOR'S PARCEL NO.: 1703362204601
Springfield TYPE OF WORK: Hospital
TYPE OF USE: Alteration Commercial
PROJECT DESCRIPTION: Surgery fan replacement and re-roof: Electrical plan review reqnired before issuance
of electrical permit
Owner: MCKENZIE WILLAMETTE REGIONAL MEDICA
Address: PO BOX 190700
SAN FRANCISCO CA 94119
Contractor Type
General
Contractor
TBD
# of Units:
Primary Occupancy Group: 12
Secondary Occupancy Group:
Primary Construction Type IA
Secondary Construction Type:
# of Bedrooms:
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Street Improvements:
Storm Sewer Available:
Special Instruction:
Notes:
Description
Type of Construction
CONTRACTOR INFORMATION
AT IU: legon aw raqulr" to
follow rules adopted by the llicgnseUtilitJ;xpiration Date Phone
tification C,'lTier. Those rules c,re set forth
1'~BUICDi'NG iNFO~~ATIONf ::IO<:-UU1-
,Jb". 'uc' "'''r w._,,:~~.~.__ "e rules by
callin[#t~f'sto.q~~:- (Note: the telephone .Lot Size:
numbeHlligIl\1iJf'sfW811k'tility Notification );;q Ft 1st Floor:
'Qq/iltOf Heat800-332 2344). ;. ;/JSq Ft 2nd Floor:
c'',,,,..'
Water Type: '.', ;'~ Sq Ft Basement:
Range Type: Sq Ft Garage/Carport
Energy path:_ __ Sq Ft Other:
Sprinkled Building; Yes Occupant Load:
I DEVELOPMENTINFORMATION ,~ . ',' ,
~~i.~~i~=:::E WORK
AUiTWJ61_~~R Tf.IIS PERMIT IS NOT
CO'MMeNe~dS MANDJJNED il1mB
AIIV 18D DAY PERlO1ll
I PUBLIC IMPROVEMENTS ~
REQUIRED PARKING
Total:
Handicapped:
Compact:
.-'
Sidewalk Type:
DownspoutsIDrains:
I Valuation Description ~
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Paee lof5
Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM20I0-00697
ISSUED: 07/01/2010
APPLIED: 06/01/2010
EXPIRES: 01/01/2011
VALUE: $ 831,944.00
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Bid Amonnt
Mechanical CIl
Use Bid Amount
Use Bid Amount
$1.00
$1.00
501,544.00
330,400.00
$501,544.00
$330,400.00
$831,944.00
06/22/2010
06/22/2010
Total Value of Project
~
Fee Description Amount Paid Date Paid Receipt Number
Plan Review Commllnd/Public $2,3 12.54 6/1/10 2201000000000000599
+ 10,10 Seismic Fee $39.94 7/1110 2201000000000000782
+ 12% State Surcharge $479.26 7/1/10 2201000000000000782
+ 5% Technology Fee $199.69 7/1/10 2201000000000000782
Building Permit $2,344.89 7/1110 2201000000000000782
Mechanical-Value $1,648.92 7/1110 2201000000000000782
Plan Review CommlIndlPublic $84.65 7/1110 2201000000000000782
+ 12% State Surcharge $6.96 7/23/10 2201000000000000866
+ 5% Technology Fee $2.90 7/23/10 2201000000000000866
Add, Alter, Extend Circ $55.00 7/23/10 2201000000000000866
Minimum/Adjustment Electrical $3.00 7/23/10 2201000000000000866
Plan Review Electrical (25%) $14.50 7/23/10 2201000000000000866
Total Amount Paid $7,192.25
I Plan Reviews I
Initial Review
06/01/2010
06/01/2010
APP LLH
Pa!!e 2 of5
CITY OF SPRINGFIELD
Building/Combination Permit
Status Issued PERMIT NO: COM20I0-00697
225 Fifth Street, Springfield, OR ISSUED: 07/01/2010
541-726-3753 Phone APPLIED: 06/01/2010
541-726-3676 Fax EXPIRES: 01/01/2011
541-726-37691nspection Line VALUE: $ 831,944.00
Fire Deoartment Review 06/01/2010 06/03/2010 APP GRG Plans Review: new roof mounted
mechanical penthouse for
replacement of surgery fan system.
Job #COM20to-00697. Occupancy
Classification: 1-2. Construction
Type: I-A. Plans reviewed under the
2007 Springfield Fire Code and 2007
Oregon Structural Specialty Code.
Provide fire extinguishers with a
minimum rating of2-A:I0-B:C
every 30 feet of travel distance or
2-A:20-B:C every 50 feet travel
distance in the new penthouse. The
top ofthe extinguisher(s) shall be
between 3 and 5 feet ahove finished
floor (2007 Springfield Fire Code
906).
Plans Sheets M-12l and 122 and
Project Manual 2113 13 notes
requirement for
extension/modification of the
sprinkler system. Suhcontractor
shall submit sprinkler plans to City
of Springfield Development Services
Building Permit Review Technician
for Springfield Fire Marshal's OfficI
review and approval (2007
Springfield Fire Code 901.2).
Extend fire alarm system to new
penthouse meeting 2007 Springfield
Fire Code and NFPA 72
requirements. Contact Deputy Fire
Marshal Gilbert Gordon
(541-726-2293) for inspections.
Structural Review 06/0112010 06/17/2010 APP CJC Need signed special inspection form-
contacted Arch: Project is under
bid, and form will be signed and
returned when contractor has been
selected.
Electrical Plan Review 06/21/2010 06/22/2010 REC BAR Need to calculate electrical plan
review fee with the signed electric
permit application.
Pa!!e 3 of 5
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Strnctnral Review
06/25/2010
APP CJC
06/25/20 IO
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2010-00697
ISSUED: 07/01/2010
APPLIED: 06/01/2010
EXPIRES: 0110112011
VALUE: $ 831,944.00
As noted- SI form to he recieved
when contractor is selected- no work
to he done until contractor is
identified ans SI form recieved hy
DSD
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.
UeollirecUnsnections ~
Framing Inspection: Prior to cover and after all rough in inspections have heen approved.
Ceiling Insulation: Prior to cover.
Roofing: Prior to installing any roof covering.
Drywall: Prior to taping.
Firewall: Located and constrncted according to plans.
Sprayed On Fireproofing: To he done during constrnction by a State Certified Special Inspector. Provide test
resports to City Building Inspector.
Strnctural Concrete: In excess of 2500 psi. To be done during constrnction by a State Certified Inspector.
Provide results to City Buiding Inspector
Epoxy Anchors: To be done by Certified Spciallnspector. Provide Inspection results to City Building Inspector.
Bolts Installed in Concrete: To be done by a State Certified Special Inspector. Provide inspection test reports to
City Building Inspector.
Special Inspection: Weld Inspection: To be done during construction by a State Certified Special Inspector with
approval from the City of Springfield. Copies of inspection results shall be provided to the City of Springfield.
Special: See Plan Reviewer or Inspectors Notes for specific requirements.
Final Building: After all required inspections have been requested and approved and the building is complete.
Rough Plumbing: Prior to cover and including required testing.
Final Plumbing: When all plumbing work is complete.
Rough Mechanical: Prior to Cover
Rough Gas: After line is installed and required testing and capped if not attached to an appliance.
Final Gas: When all gas work is complete.
Final Mechanical: When all mechanical work is complete.
Rough Electric: Prior to Cover
Final Electric: When all electrical work is complete.
Ceiling Grid: After drywall approval but prior to cover.
Paee 4 of5
Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2010-00697
ISSUED: 07/01/2010
APPLIED: 06/01/2010
EXPIRES: 01/0112011
VALUE: $ 831,944.00
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
By signatnre, 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 ofthe Community Services Division, Building Safety.
I further certify that only contractors and employees who are in compliance with ORS 701.005 will he used on this project.
I further agree to ensure that all required inspections are reqnested 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 Contractors Signature
Date
Pal!e 5 of5
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
City of Springfield Official Receipt
Development Services Department
Public Works Department
RECEIPT #:
2201000000000000866
Date: 07/23/2010
1l:14:44AM
Job/Journal Number
COM20 I 0-00697
COM2010-00697
COM20 I 0-00697
COM20 I 0-00697
COM20 1 0-00697
Payments:
Type of Payment
CreditCard
cReceintl
Description
Add, Alter, Extend Circ
Minimum/Adjustment Electrical
Plan Review Electrical (25%)
+ ] 2% State Surcharge
+ 5% Technology Fee
Amount Due
55.00
3.00
14.50
6.96
2.90
$82.36
Paid By
JEFF GUCKENBERGER
Item Total:
Check Number Authorization
Received By Batch Number ; Number How Received
Amount Paid
cjc
o 1530d In Person
Payment Total:
$82.36
$82.36
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