HomeMy WebLinkAboutPermit Mechanical 2013-4- SPRINGFIELD 225 Fifth St
CITY OF SPRINGFIELD Springfield,OR 97477
`1.11 Phone: 541-726-3753
Building / Residential Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2013-00805
www.springfield-or.gov permitcenter@springfield-or.gov
PROJECT STATUS: Issued ISSUED: 04/22/2013 EXPIRES: 10/19/2013
STATUS DATE: 04/22/2013 APPLIED: 04/22/2013
SITE ADDRESS: 1681 RAMBLING DR,Springfield,OR 97477 SCOPE: Mechanical Only
ASSESOR'S PARCEL NO: 1703252102700 TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: Change out Heat Pump
OWNER: SMITH JEANNE M Phone Number:
ADDRESS: 1681 RAMBLING DR
SPRINGFIELD OR 97477
CONTRACTOR INFORMATION `
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
Mechanical Contractor APPLIED REFRIGERATION TECHNOLOGY INC CCB 133020 10/29/2014 541-830-5513
_ INSPECTIONS REQUIRED
Inspections
2300 Rough Mechanical Rough Mechanical: Prior to Cover
2999 Final Mechanical Final Mechanical: When all mechanical 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 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 Contracto ignature Da e
ATTENTION: Oregon law requires you to NOTICE:
follow rules adopted by the Oregon Utility THIS PERMIT SHALL EXPIRE IF THE WORK
Notification Center. Those rules are set forth
in OAR 952-001-0010 through OAR 952-001- AUTHORIZED UNDER THIS PERMIT IS NOT
0090. You may obtain copies of the rules by COMMENCED OR IS ABANDONED FOR
calling the center. (Note: the telephone ANY 180 DAY PERIOD.
number for the Oregon Utility Notification
Center is 1-800-332-2344).
Springfield Building Permit 4/22/2013 8:46:54AM Page 1 of 1
SPRINGFIELD CITY OF SPRINGFIELD •
225 Fifth St
.::17ON-4 TRANSACTION RECEIPT SpringfieId,0R97477
541-726-3753
811-SPR2013-00805
www.springfield-or gov 1681 RAMBLING DR permitcenter@springtield-or.gov
RECEIPT NO: 2013000795 RECORD NO:811-SPR2013-00805 DATE:04/22/2013
[DESCRIPTION - - _.__V_:A000UNTCODE/TRANSCODE_y 2:.:_AMOUNT_DUE -
First Appliance Fee 224-00000-425604 1006 80.00
State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 9.60
Technology fee(5%of permit total) 100-00000-425605 2099 4.00
TOTAL DUE: 93.60
LPAYMENT TYPE. :PAYOR 'cdswER JLARSary ','` COMMENTS ., _ - `'AMOUNT PAD . 1
..---------------- --- -----_ _... - ---------
Check APPLIED REFRIGERATION 93.60
2219 TECHNOLOGY INC
TOTAL PAID: 93.60
Mechanical Permit Application A DEPARTMENTrUSE ONLY .�
. . ,
i His s''''''''''' ,a Permit no.:o 1/Zo(3 DOSAS°C1 LO SRRINGFIELM„ GO ,
225 Fifth Street• Springfield,OR 97477 • PH(541)726-3753 • FAX(54l)726-3689 r
Date: `1'/Z Z//j
This permit is issued under OAR 918-440-0050. Permits expire if work is not started within 180 days of issuance or if work is
suspended for 180 days.
• ,Q, ,. .ICATEGORY 'OF=CONSTRUCT.ION *P- t:Er.::' ."FEE-'SCHEDULE ;
/Residential ❑ Government ❑CommercialResldential - _ :._Cost Total
' - - - pp / S8 .0 z cbst
JOB' SITE. I'IFORMATION7AND ,LOCATION i; ._ First A Appliance 0.00 $
Job site address:vo)i k 2 ,,I,V Or. Furnace/burner including ducts and vents
/� `` ee Up to 100k BTU/hr. $18.50 $
City: S a. Te:W State: dQ ZIP cog
Reference 1 Taxlot Over 100k BTU/hr. $22.00 $
Heaters/stoves/vents
,, , (`tt)ECRIPTION`;OF:WORic- ;,' r.,;' 1 Unit heater $18.50 $
` t.9\4,%a \ t..,\-- `?o Wood/pellet/gas stove/flue $42.00 $
J Repair/alter/add to heating appliance/
•
, , . refrigeration unit or cooling system/ $80.00 $
y
._s "PROPERTY,'OWNER 3,.,= _, , „ absorption system
Name: 'S'C wv �. S v‘4.\\„,, Evaporated cooler $14.50 $
`4 ( p // y/rt� Vent fan with one duct/appliance vent — $10.00 $
Address: 4 `4 tfgB_ / c.
City: //,/1,� � State: 04 ZIP: 2 V7 7 Hood with exhaust and duct $14.50 $
•I/ L
Floor furnace including vent $80.00 $
Phone: - - Fax: - - Gas piping
E-mail: One to four outlets $7.50 $
This-installation is being made on property owned by me or a Additional outlets(each) $4.50 $
member of my immediate family, and'is exempt from licensing Air-handling units,including ducts
requirements under ORS 701.010. Up to 10,000 CFM $12.00 $
Signature: Over 10,000 CFM $22.00 $
}`7`f t, 'ai ;CONTRACTOR'INSTALLATION, Compressor/absorption system/heat pump
Business name: \� ff,,J 't� d ,ah L.
Up to 3 hp/100k BTU $18.50 $
pC Up to 15 hp/500k BTU $32.00 $
Address: \ .('- (c, .„g Up to 30 hp/1,000 BTU $47.50 $
City: c\ikeicsnA State:0-Q ZIP: 171 Up to 50 hp/1,750 BTU $62.50 $
Phone:Sl(-2b- oq cg Fax:co(-89D-t.]6((�g - Over 50 hp/1,750 BTU $104.50 $
E-mail: Incinerators
Domestic incinerator $22.50 $
CCB license no.:
Vck) a1 ICommercial,'`.1 fim!' s'.,, - , , n t.
Print name: \�r-,>.. Cr,C_. / Enter total valuation of mechanical system
f and installation costs$
Signature: Enter fee based on valuation of mechanical system, etc. $
_- ° - ",Cost ==Total k`
Miscellaneous fees/. r� . -;..item s . ea , - -cost ,
- Reinspection $80.00 $
Specially requested inspections(per hr.) $80.00 $
Regulated equipment(unclassed) $14.50. $
Each additional inspection:(1) $80.00 $
.xj r "- -'s,, :•APPLICANT.:USE a.r ', ' r,]. . _>
(A)Enter subtotal of above fees(or enter set
minimum fee of $80.00) $
(B)Investigative fee(equal to[A]) $
(C)Enter 12%surcharge(.12 x[A+B]) $
(D)Seismic fee, 1%(.01 x [A]) $
• (E)Technology Fee(5%of[A]) $
440-2545-1(4/1/2013/COM) TOTAL fees and surcharges(A through E): $73 2-