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Home My WebLink AboutPermit Electrical 2010-10-8 , .QEPARTMENT liSE.ONLY,' r:;~ Perrrril no~~" ~ ~~ . Date \t)" .\0 This ~nnit i~ issued under OAR 9J8-309~OO- Permits are nontransferable. Permih expire.ifwork is not started ",'ithin 180 days ofissuanlX or if work is suspended for 180 days. '__ LOCAL GOVERNMENT.APPROVAL ,.-c'.. Zoning appro,.al verified? 0 Yes 0 No . .... " , CATEGORY OF . CONSTRUCTION . o RL~idential 0 Govenunent l 0 Conum~cial , JOB SITE ,INFORMATION .ANO"LOCATION.. 1.000 sq. fl. or 1= (4) \:-At. " ~ C 1- r...ach additional 500 sq. fL or portion Job site address: ~""'rt(II} 1..:lI.;;:::sv Ihe,oof City: -~~,p late: OQ...I z.lp:q~'1l IJmitedenergy(2) Subdivisio~: \. l;"'}' _~ Lot n~\ Each !fIanufat?lured home or modular .. DESCRIPTION OF W '"\ \pr. oj'o. dwelhngservlcemfeede,(2) rJ Jj() J-.-~f'\ r-rt'\' I :'.~ ~ n ~rvicesorreedus: iPlstaflal;ou, alteration, relocation \~,~~rt " f' fY>1( I ~ ('1 "tb 200 amps or less (2) / $ 81.00 $ " PROPERTY,OWNIOR ,', '.' 201 to 400 amps (2) $ 95.00 $ Name: ,,^~1 Oll:\-:t. O,\~~\\ ,,,-,~ 401 10 600 amps (2) $158.00 $ Address' t\ ~ ~ ~O '\=- . 60 1 to 1.000 amps (2) $205.00 $ CityQ,c\" ....)"'tate:~ I ZIP:,\<\\\'t I Oved.OOO amp" or volts (2) $469.00 S Phone: _ _ I Fax: _ _ Reconnect only (2) $ 63.00 $ E-mail: ITe-mporaryservicesorfeedns:inslaUation.allerafion. relocation This installation is being made on residential or farm property 200 amps OT less (2) $ 63.00 $ owned bv me or a member ofmv inuncdiate tamil\'. This 201 to 400 amps (2) $ 87.00 S property'is not intended for sale: exchange. lease. or rent. OAR 479.540(1) and 479.560(1). Signature: " CONTRACTOR INSTALLATION' . : '. ' '.' . Business name: ,~(_ L I ~. ( I i ~ -:-r~, . AdUrc,,: Z-1"51 Ibn. ~UI1..{ City: <' 7( 0 fA Stale' au I ZIP: Q14-11 Phone: ~I :--,...,,,_ r. -. I Fax:")<H -i4b-~g-.ss E-m"il: '"";;>p,(Q) ,jKc..-e::l~.{..Ol'Y) CCB Iicen';' no.: 4'512...<1 I BCD license n';.: 2.0-2...1'C- Signing supervisor's license no.: ~'il''5.s ! Print name of signing supervisaL \'." , hi Jr )f 11 n lQar~rl ~ature of signing supervisor,: -' ~ -' ~l 'U ~\)~ ~ ~ -I40-25&4-J (9.'08fCOM) '., ' '.,0' :' FEE SCHEDULE- : ".' .' .' Total -, cost. _~umber orins';cti~~'~rite~ (,:-f~;.':> Q~;. ,. ~ ~t- Residential, pE'r unit, Sf'rvice included: $134.00 $ $ 25.00 $ $ 32.00 $ $ 63.00 $ h XI 401 to 600 amps (2) $126.00 $ Ovet" 6qo amps or 1.000 \'olts, see services or feeders section above Branch circuits: new, alteration, ex/ension per panel a. Fee for bronch circnits with purcha.o;e ofa service or feeder fee: Each branch circuit I $ 6.00 $ b. Fee for branch circuits without purchase of a service or feeder fee: First branch circuit (2) Each add-itionalbranl;h circuit $ 55.00 $ $ 6.00 $ J=.< MiScdlaneous fei"S: service or feeder not included Each pump or irrigation circle (2) $ 63.00 $ (as S Each sign 0"( outline lighting (2) Signal L-lrc.:uit or a Ijmited~energy panel. alteration. or e),.-rension (2) $ 63.00 $ 63.00 $ Each additional inspPCtion: (I) '. -,:' . . .' ,": "". APPUCANT.USE" $58.00 $ '. ~ . ;c (A) Enicr subtotal of above fees (Minimum Pennit Fee S58.(0) (B) I--:nter 12% surcharge (.12 x lAD (C)Technotogyf=ee(5%of(A)) It ' TOTAL fees and surcharges (A through C): $ /.>~ $ f6b $/ f' '/7? 1$ - ~'2- /O'L. SP~~~\ING FI..E.l 0 B$; .~ll'.,y~ . ~.t ~~ 2Z",r,;,,= OREGON CITY OF SPRINGFIELD 225 Fifth St Springfield,OR 9747Z Phone: 5,i1-726-3753 Inspection Phone: 541-726-3769 Fax: 541-726-3676 www.ci.springfield.or.us Building I Commercial Permit PERMIT NO: 811-SPR2010-00472 IVR Number: 811134578632 permitcenter@<:.i,springfield,or,us PROJECT STATUS: Issued STATUS DATE: 10/8/2010 ISSUED: APPLIED: 10/8/10 EXPIRES: 4/6/2011 VALUE: $0.00 SITE ADDRESS: 1460 G ST, Springfield, OR 97477-4112 ASSESOR'S PARCEL NO: 1703362204601 SCOPE: Electrical Only WORK INVOLVED: New TYPE OF STRUCTURE: Commercial PROJECT DESCRIPTION: Nuclear medicine machine OWNER: ADDRESS: MCKENZIE WILLAMETTE REGIONAL MEDICAL CTR PO BOX 190700 SAN FRANCISCO CA 94119 Phon,e Number: I CONTRACTOR INFORMATION ~ Contractor Type Contractor Name . JK GUCKENBERGER ELECTRIC INC Lic Type CCB Lic No 45129 Lic Exp 04/24/2012 Phone 541-746-4656 aUILDll';lG INFORMATION ~ # of Units: o # of Stories: I Height of Structure: Ty pe of Heat: Water Type: Range Type: Hazmat: Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage: Sq Ft Carport: Sq Ft Other: Occupancy Load: -.':~ # of Bedrooms: Sprinkled Building: Fire Alarms: Electrical Specialty Code Edition: Springfield Fire Code Edition: Mechanical Specialty Code Edition: Municipal I Development Code: Plumbing Specialty Code Edition: Residential Specialty Code Edition: O I quStructura! -"pecialty Code Edition: ATTENTION: regon aw re II~' yuu .0' . follow rules adopted by the Clreg~';_~~~~mte Information . . Notification Center. Those ruls. Engineered Flllh OAR 952~001-001Othrough OAR 952~001- Fill Volume: 0090. You may obtain copies of the rules by Flood Hazard Ar'eli.lling the center. (Note: the telephone Land Hazard A"nUmber for the Oregon Utility Notification Retaining Wall: Center is 1 ~800~332~2344). Soils Report Required: I Energy Path: ~ - liCE: E IF THE WORK ,liS PERMIT SHAll ~~~ PERMIT IS NOT .UTHORIZEO UN(\ER ANDONED FOR COMMENCED OR IS AB ANY 1 SO DAY PERIOD. Springfield Building Permit 10/8/2010 10:18:38AM Page 1 of 3 www.ci.springfield.or.us CITY OF SPRINGFIELD Building I Commercial Permit PERMIT NO: 811-SPR2010-00472 225 Fifth St Spring,field,OR 97477 Phone: 541-726-3753 Inspection Phone: 541-726-3769 Fax: 541-726-3676 permitcenler@ci.springfield.or.us IVR Number: 811134578632 PROJECT STATUS: Issued STATUS DATE: 10/8/2010 ISSUED: APPLIED: 10/8/10 EXPIRES: 4/6/2011 VALUE: $0.00 SITE ADDRESS: 1460 G ST, Springfield, OR 97477-4112 ASSESOR'S PARCEL NO: 1703362204601 SCOPE: Electrical Only WORK INVOLVED: New TYPE OF STRUCTURE: Commercial PROJECT DESCRIPTION: Nuclear medicine machine DEVELOPMENT INFORMA TION ~ Fronlyard Setback: Interior Setback: Sideyard Setback: Rearyard Setback: Solar Setback: Overlay Dist: # Street Trees Reqd: Paved Drive Reqd: % of Lot Coverage: Highest point on structure to north property line: REQUIRED PARKING Total: Handicapped: Compact: PUBLIC IMPROVEMENTS ~ Street Improvements: Storm Sewer: Storm Sewer Available: Speciallnstructon: Subdivision Accepted: Notes: Sidewalk Type: Downspout/Drains: Valuation Description' ~ Description Tvpe of Construction Unit Amount Unit Tvpe Unit Cost Value Description Services 200 amps or less Branch circuits with service or feeder each circuit Signal circuit(s) or limited-energy panel, alteration, or extE State of Oregon Surcharge (12% of applicable fees) Technology fee (5% of permit total) Total Amount Paid Amount Paid $81.00 $1200 $63.00 $18.72 $7.80 $182.52 Date Paid 1 0/08/201 0 . --'-_..~--~".._~- 1 0/08/201 0 10/08/2010 10/08/2010 10/08/2010 Receiot # 374541 374541 374541 374541 374541 Springfield Building Permit 10/8/2010 10:18:38AM Page 2 of 3 SP~~N.G.~.FIE~D . l1m,t" .. .::t:~ .07>. ':OREGON CITY OF SPRINGFIELD 225 Fifth St Springfield,OR 97477 Phone: 541-726-3753 Inspection Phone: 541-726-3769 Fax: 541-726-3676 w-N\N. ci .springfield .or. us Building I Commercial Permit PERMIT NO: 811-SPR2010-00472 IVR Number: 811134578632 permitcenter@ci.springfield.or.us PROJECT STATUS: Issued STATUS DATE: 10/8/2010 ISSUED: APPLIED: 10/8/10 EXPIRES: 4/6/2011 VALUE: $0.00 SITE ADDRESS: 1460 G ST, Springfield, OR 97477-4112 ASSESOR'S PARCEL NO: 1703362204601 SCOPE: Electrical Only WORK INVOLVED: New TYPE OF STRUCTURE: Commercial PROJECT DESCRIPTION: Nuclear medicine machine [ <0,-"...,,'<f;0;~.-:~~ {:~'j/ ~.~0:::;~,';'~J,;~!t'iJ~::1l ,,;;J~;~~~~p'4~';;;::r-;t~~~;"I?'r~~l#,~~G.~- ":~~t'~{'2 -,:'::~::7<x;:~'__:::,,-. Department Received Due Date Completed Result Reviewer Application Acceptance 10/08/2010 10/08/2010 10/08/2010 Over the Counter Nancy Machado Comments: Permit Issuance 10/08/2010 10/08/2010 1 0/08/2010 Issued Nancy Machado Comments: Electrical Review 10/08/2010 10/08/2010 10/08/2010 Not Required Nancy Machado Comments: Over the counter permit Initial Review 10/08/2010 10/08/2010 10/08/2010 Over the Counter Nancy Machado Comments: Over the counter permit INSPECTIONS REQUIRED ~ Inspections 4220 Electrical Service Electric Service: Approval required prior to utility company energizing service. 4500 Rough Electrical 4550 Limiled Energy 4999 Final Electrical 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 Springfieid 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 Springfield Building Permit , 10/8/2010 10:18:38AM Page 3 of 3 S~i~..F~E~~ ~.'."'1!It~ ,.:-~~,',~~ C" OREGON www.d.springfield.or.us TRANSACTION RECEIPT 811-SPR2010-00472 1460 G ST CITY OF SPRINGFIELD 225 Fifth 5t Springfield, OR 97477 541-726-3753 permitcenler@ci.springfleld.or.us RECORD NO: 81 I-SPR20 1 0-00472 DATE: 10108/2010 ~:~~~r;l~;:~':'.~T#:;:::S:j:s:~',~::zt.. ':; "~Y~G~_O)J]~j~G~Qtn;"?~:;\:j~ r-~~' ~i~M9_U~Kl)JtE'-,":,,": .. <:",,"i~~: .~! 224-00000-426102 $81.00 224-00000-426102 $12.00 224-00000-426102 $63.00 821-00000-215004 $18.72 100-00000-425605 $7.80 TOTAL DUE: $182.52 L;eA.YJ!'l~:~JtJPl;i..i;;;i+pA:'yORf~:s;:;cAsFiE~iNM~~p':d;;''lf;CQM~~~J.S~'!';}1~;':h;z:;.~1;""'::"i ':AMQUNT;PAIDc~, ; :;::;7'. 7illJ RECEIPT NO: 2010000517 [OESCRIR:'r10N''''; 0'::'i..;40;;.'h:.;;; _'" ',.,"'<:. ..J,,,,,,,,".,, 'he .. ,_" " .. Services 200 amps or less Branch circuits with service or feeder each circuit Signal circuit(s) or limited-enerQY panel, alteration, or extension Slate of Oregon Surcharge (12% of aPe'icable fees) Technology fee (5% of permillolal) Credil Card 005850 JK GUCKENBERGER ELECTRIC INC $182,52 $182,52