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Home My WebLink AboutPermit Electrical 2007-5-30 ZON ~U~ INITIALS Vcf\ DATE ~.'~ SOURCE J!.~ ~~ 22S FIFfH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-37S3 . FAX: (541)726-3689 ELECTRICAL PERMIT APPLICATION City Job Number COW'\. zoc 7- OC 7 6 ~ Date --~""'-""""" ,-. ...- . ,.,','C---,-" ",,"-~:.,...- "'-)"'7::-.""""- ,,- "'_ . . -'" 3. h;(JOMPLiib'FEIFSGHEDULERELOW. ~_~. ". ,;:.~ .~,".-'.."~'';;..:jt.',' LEGAL DESCRIPTION: 170336'2-2 A.Ne~"R~side~1ial,":'single or Multi-FamiJy per dwelling unit. Service Included A-ckL ~ c(r~+r 1000 sq_ ft. or less Each additional 500 sq. ft or portion thereof Each Manufact'd Home or Modular Dwelling Service or Feeder $106.00 JOB DESCRIPTION: $ 19.00 Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is Suspended for 180 days. $50.00 2. C01\7RACTOR INSTALLATION ONLY B. Scnkcs or Feeders - fnstallalion, Alterations or Relocation: City ~~~lcl ~\-\GI f:, LkL-tn0 -X-tJG 200 Arrips or less '~ 20 I Amps to 400 Amps LOn S +- 401 Amps to 600 Amps 60 I Amps to 1000 Amps Phone i4b-'-fhSb Over 1000 AmpsNoIts Reconnect Only $ 63.00 $ 75.00 $125.00 $163.00 $375.00 $ 50.00 Electrical Contractor Address 2...1 '51 Supervisor License Number q.cg lS S C. T("mporlu-:;' S~'n'kes or Feeders Expiration Date 10 - I - J Installation, Alteration or Relocation Expiration Date 200 Amps or less $ 50.00 2-0 - L( '"1 L Mt.frU;f: 201 Amps to 400 Amps $ 69.00 fH/~ PERM/lesl Amps to 600 Amps $100.00 I - I -08 I.l1riiaIJ/1Wo~~ Jr~jI'lEWO'TlfeI'w!jjiit above Signature of Supervising Electrician COMMENC(D U~~~elKHfBuflfRMIT IS NOT ANV 1 BO DAY ~~~~lllilGfl1ill~ Per Panel , . Jii~tQQmt $ 43.00 Each Additional Circuit or with Service or Feeder Permit 5( $ 3.00 .~ Constr.Contr.Number Address lIt!; /lAwtdk - ~t lIs 2C( , Owners Name fA) ~~e- J'-Ib D (,\ ~F~ E. Miscellaneous (Service/feeder not inclUlletl) -Each Installation , Pump or irrigation $ 50.00 ATTi::NTIOBiW'~lf Ja!lJlM~Ulres you in $ 50.00 OWNER INSTALLATION .follow rules Bi'iia~EI~ub-~i3't1rg!Jbn uri~ty $ 25.00 The installation is being made on property I own ~lMtcation CliDltmfa lli~G(MlE.u.€,tli:l set fori $ 45.00 is not intended for sale, lease or rent. In OAF< 9~"\IQ~~la~~tGlA~atbB..JJlQ is $45.00 + Surcharges 0090. .YO~4~~~~~' ~>~.E~~191Jtiltrules I b 7 caH~" me c~mtar. Note: the te/ephon~ ::tt: rcutfflbef tor t~,~ ~~ .mt'tl'tffltv. Notiticatiun ~ 10% A. s~~tlj'_e7f" h 7D_ Phone City Owners Signature: Inspection Request: 726-3769 Shared Drive(f:}'Building FormslElectrical Permit Application 8-06.doc Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2007-00763 ISSUED: 05/30/2007 APPLIED: OS/29/2007 EXPIRES: 11/30/2007 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: Hospital TYPE OF USE: Remodel PROJECT DESCRIPTION: ACM - adult and Children Medicine Renovation Commercial Owner: MCKENZIE WILLAMETTE REGIONAL MEDICA Address: PO BOX 190700 SAN FRANCISCO CA 94119 I CONTRACTOR INFORMATION I Contractor Type Electrical Contractor J K GUCKENBERGER ELECTRIC INC License 45129 Expiration Date 04/24/2008 Phone 541-746-4656 BUILDING INFORMATION I # of Units: # of Stories: Primary Occupancy Group: Height of Structure: Secondary Occupancy Group: Type of Heat: Primary Construction Type Water Type: Secondary Construction Type: NO TIC E : Range Type: # of Bedrooms: THIS PERM Energy Path: IT SHMPriliiXJem'Uj~' : n/a AUTHnRI709 vIm!; ill ~ ~O~K COMMENC~ M~bR~~W(/)N I ANY 180 DAY PERIOD u rUN Overlay Dist: # Street Trees Rqd: Paved Drive Rqd: % of.Lot Coverage: Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft Basement: Sq Ft Garage/Carport Sq Ft Other: Occupant Load: Frontyard Setback: Side 1 Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: REQUIRED PARKING Total: Handicapped: Compact: Street Improvements: Storm Sewer Available: Special Instruction: ATT~NTIl!Uijt-J5=_tl\j~Rgy~~~u to follow fule& adopt;d by the Oregon UtUit}'Sidewalk Type: \ioHflc8tion Center. Those rules are set f€UbownspoutslDrains: In OAt< 952~Ot1.001 0 through OAR 952-00' 0090. You r'rl&Y obtain copies of the rules \ calling the center. (Note: the telephone rU.JtflhAf 'lor the Or800n Utility Notification . _d -::-4i} I Valuation Des~~iDti~.; ~ Notes: Description Type of Construction $ PerSq Ft or multiplier Square Footage or Bid Amount Value Date Calculated Paee 1 of 2 Status Issued 225 Fifth Street, Springfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Total Value of Project Fees Paid' Fee Description + 10% Administrative Fee + 5% Technology Fee + 8% State Surcharge Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add Amount Paid Date Paid $6.70 $3.35 $5.36 $43.00 $24.00 5/30/07 5/30/07 5/30/07 5/30/07 5/30/07 Total Amount Paid $82.41 I Plan Reviews I CITY OF SPRINGFIELD - Building/Combination Permit PERMIT NO: COM2007-00763 ISSUED: 05/30/2007 APPLIED: OS/29/2007 EXPIRES: 11/30/2007 VALUE: Receipt Number 1200700000000000653 1200700000000000653 1200700000000000653 1200700000000000653 1200700000000000653 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. Reauired InsDections I 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 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 Contractors Signature Pa2e 2 of2 Date 225 Fifth Street Springfield, Oregon 97477 541':726-3759 Phone Cit-. qf Springfield Official Receipt D, Jopment Services Department Public Works Department RECEIPT #: 1200700000000000653 Date: 05/30/2007 3:03:54PM Job/Journal Number COM2007-00763 COM2007-00763 COM2007-00763 COM2007-00763 COM2007-00763 Description Add, Alter, Extend Circ Add, Alter, Extend Circ Ea Add + 5% Technology Fee + 8% State Surcharge + 10% Administrative Fee Payments: Type of Payment Paid By CreditCard JEFFREY GUCKENBERGER Item Total: Check Number Authorization Received By Batch Number Number How Received djb 005944 In Person Payment Total: Amount Due 43.00 24.00 3.35 5.36 6.70 $82.41 Amount Paid $82.41 $82.41 cReceintl Page 1 of I 5/30/2007