HomeMy WebLinkAboutPermit Mechanical 2013-4- SPRINGFIELD 225 Fifth St
CITY OF SPRINGFIELD Springfeld,OR 97477
"t` ° " Phone: 541-726-3753
n# OREGON
Building / Residential Permit Inspection Phone:541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2013-00786
www.springfield-or.gov pormitcenter @springfield-or.gov
PROJECT STATUS: Issued ISSUED: 04/18/2013 EXPIRES: 10/15/2013
STATUS DATE: 04/18/2013 APPLIED: 04/18/2013
SITE ADDRESS: 878 54TH PL,Springfield,OR 97478 SCOPE: Mechanical Only
ASSESOR'S PARCEL NO: 1702331201901 TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: DHP
OWNER: RMK INVESTMENTS LLC Phone Number:
ADDRESS: 2656 33RD ST
SPRINGFIELD OR 97477
L CONTRACTOR INFORMATION
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
Mechanical Contractor KENT WITHAM AIR INC CCB 189283 01/20/2014 541-543-6580
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 ntractor Signature Date
•
NOTICE: •
THIS PERMIT SHALL EXPIRE IF THE WORK ATTENTION: Oregon law requires you to
AUTHORIZED UNDER THIS PERMIT IS NOT follow rules adopted by the Oregon Utility
;0f49MENCED OR IS ABANDONED FOR Notification Center. Those rules are set forth
in OAR 952-001-0010 through OAR 952-001-
NW 180 DAY PERIOD. 0090. You may obtain copies of the rules by
calling the center. (Note: the telephone
. number for the Oregon Utility Notification
Center is 1-800-332-2344).
Springfield Building Permit 4/18/2013 3:54.46PM - Page 1 of 1
•
SPRINGFIELD CITY OF SPRINGFIELD
r X 225 Fifth St
,!/e TRANSACTION RECEIPT Springfield,OH 97477
t OREGON 541-726-3753
811-SPR2013-00786
www.springfield-or.gov 878 54TH PL permitcenter @springfield-ar.gov
RECEIPT NO: 2013000779 RECORD NO:811-SPR2013-00786 DATE:04/18/2013
9q io3 p[o7 Ckw ;=A 'rt'bts(_._w' :-4C F1 ,'N"L::.1. .,ACCOUNTCOD RANSCODE' " tT JAAMOUNTDUE'.;:
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
.BAYMENT;TYP.E BAY.ORASH'� IER":F.iuH50N ..COMMENTS �' �- ?MOUNT MAID"ga
Check KENT WITHAM AIR INC 93.60
2177
TOTAL PAID: 93.60
Mechanical Permit Application DEPARTMENT,USE ONLY
} .-jk r °4T A SPHINGFIELO LR+v°'S*_PI �7
VIDLO fS'PAINGFIELD UREGOLY� 0" Permit no.:�7I�(� OO/�l
0.t .. �t�x..RS&3.M1.'3".p�.,1'k.&ff;FAX 31 :9�'C ..AR.....u,,.r_
' 225 Fifth Street♦ Springfield,OR 97477 • PH(541)726-3753 (541)726-3689 y/ / s
Date: (�V' �
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.
i ;, ICATEGORY'OF";CONSTRUCTION , ; ,'b= h,e. Az; , ', FEE SCHEDULE
' !Cost ' Total.
❑ Residential ❑Government 0 Commercial R sl
ederitial ; n, ' rT.x;'i= Qty .a?ea. , • ',;cost ..:
JOB';SITE,INFORMATION.L•AND•=t'OCATIONtr'; "; •First Appliance 7 $80.00 s a
Job site address: g7 3' ,S'y I'x Furnace/burner including ducts and vents
Up to 100k BTU/hr. $18.50 $
City: 5Rrl nq c P I a. State: o\ . ZIP: 97 978
Over 100k BTU/hr. $22.00 $
'Reference: Taxlot
Heaters/stoves/vents
;;;,-;;; r, r -r- DESCRIPTION°OF WORK? k 'Pi=`. Unit heater $18.50 $
T IAA-6,[1 r u c,+-1E 6-5 Hfoir-(uwt R Wood/pellet/gas stove/flue $42.00 $
Repair/alter/add to heating appliance/
{ refrigeration unit or cooling system/ $80.00 $
n;� . ,__ 3"ROP.,ERTY`OWNER, _ t{v )=: ,i absorption system
Name: Rom KeP[or+ RMK TV.e34-h.(e43 Evaporated cooler $14.50 $
Address: 1,9656j 53 -R a- Vent fan with one duct/appliance vent $10.00 $
Hood with exhaust and duct $14.50 $
City: •S P F'D State: nR_ ZIP:` 79 7g
Floor furnace including vent $80.00 $
PhoneYZf-72? 'Q 970 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 $
xk s?CONTRACTOR'INSTALLATION !A:1; :,J Compressor/absorption system/heat pump
Business name: Kew Lot -{�gyvt 4I c Tv,L Up to 3 hp/look BTU $18.50 $
Up to 15 hp/500k BTU $32.00 $
Address: P o Be 17.3-6 Up to 30 hp/1,000 BTU $47.50 $
City: sPrI J .Re 1 d State:U R ZIP: C7477 Up to 50 hp/1,750 BTU $62.50 $
Phone:0 S`I3- 66-8-0 FaxS//-L36- '7/962%o Over 50 hp/1,750 BTU $104.50 $
E-mail: KOot1,p- 09 s., Hd4-1M j ( Incinerators
[&��83 Domestic incinerator $22.50 $
CCB license no.: O
'•.Commercial =,i-1 pt 4 .,.a q , 'Sl
Print name: '<p,& d-lAAYy\ Enter total valuation of mechanical system
/ i and installation costs$
Signature: ( Enter fee based on valuation of mechanical system,etc. $
Miscellaneous fees` blue : "]hems !east Iw cost, 'r.
Reinspection $80.00 $
Specially requested inspections(per hr.) $80.00 $
Regulated equipment(unclassed) $14.50. $
Each additional inspection:(1) $80.00 $
[Mitr ".r ;;APPLICANTS USE;s;. °4N4 ,'.j--'
(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 6�