HomeMy WebLinkAboutPermit Mechanical 2013-6-4 Mechanical Permit Application DEPARTMENT USE ONLY ._
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;; CIxTY'OE'S'ERI FIELD OREGON; Permit no /3 '
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225 Fifth Street• Springfield,OR 97477 • PH(54l)726-3753 • FAX(541)726-3689 r *r ailP u' Date: L'? - t/ -/
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.
CATEGORY.---'OFCGONSTRUCTIOkl:; '; i; ;, ,`F,EE SCHEDULE ,
residential ❑Government ❑Commercial :`Residential - r ',/f Q east " ,cost)
3` ' $80.00 $�Q Y,JOB;SITE`INFORMATIONAND`,LCATION 3 I First Appliance
Job site address: 4 �r Furnace/burner including ducts and vents
_ 102 � Pz,�gxA�->_
City: 5f /- State: 0I` ZIP:t`�frid7 Up to100kBTU/hr. $18.50 $
Reference: 1 7�3 Z 6 4 ( Taxlot.Ot(3't5 c-3
Over I OOk BTU hr. $22.00 $
5ti �'DESCRIPTION`OF WORK/v. y; Heaters/stoves/vents
'� = ] �•''2 Unitheater $18.50 $
crc'l2 5c (-}0_1y1 Wood/pellet/gas stove/flue $42.00 $
('' A Repair/alter/add to heating appliance/
t�"�, ,µ, _ y refrigeration unit or cooling system/ $80.00 $
m r k 4 I'fIPROPERTY�.OWNER,,',± F < .; "; absorption system
Name: r - Evaporated cooler $14.50 $
4\r S �� Vent fan with one duct/appliance vent $10.00 $
Address: %02.9 pz c, n'r v-7
Hood with exhaust and duct $14.50 $
City: s � p% State:d2 ZIP:CI-pp) Floor furnace including vent $80.00 $
Phone: - - J 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 $
'I ~;CONTRACTOR INSTALLATION ` «n ` th Compressor/absorption system/heat pump
.1 �, Y ^ ro Up to 3 hp/100k BTU $18.50 $
Business name: J�, Qr�
A`7 Up to 15 hp/500k BTU $32.00 $
Address: r 1 d �n-x Up to 30 hp/1,000 BTU $47.50 $
City: G Dp-T State:OZ. ZIP:Qfl L(IC Up to 50 hp/1,750 BTU $62.50 $
Phone:r;GI 1..4J j _0 4.t7 9 Fax: - - Over 50 hp/I,750 BTU $104.50 $
E-mail: Incinerators
Domestic incinerator $22.50 $
CCB license no.: 77c-`-. Comrnetcial ;::: In, ;rii 1 ,,
Print name: ut C).7,.‘ lbQ 0; f Enter total valuation of mechanical system
/ ,/�/ and installation costs$ .
Signature: - CALL Enter fee based on valuation of mechanical system,etc. $
r,Miscellaneous"'if--e e-
ees; i' Items ;',"cost It". Total r
Reinspection $80.00 $
Specially requested inspections(per hr.) $80.00 $
Regulated equipment(unclassed) $14.50. $
Each additional inspection:(1) $80.00 $
ti:1 , `1 ; w'e 'APPLICANT USEt ;l`: _I:w' c.'>
- (A)Enter subtotal o£above;fees{pr enter set rte,
minimum fee of $80.00) ,) $ CS
C
(B)Investi $tiv_e_fee(equaYto[A]) $
(C)Enter 12%surcharge(.12 x[A+B]) $ f'
(D)Seismic fee, 1%(.01 x[A]) $
(E)Technology Fee(5%of[A]) $ u r
440-2545-1(4/1/2013/COM) TOTAL fees and surcharges(A through E): $ 7'3 U°
SPRINGFIELD -- 225 Fifth St
` CITY OF SPRINGFIELD Springfield,OR 97477
`C�i Phone: 541-726-3753
OREGON Building / Residential Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2013-01151
www.springfield-or.gov permitcenter @springheld-or.gov
PROJECT STATUS: Issued ISSUED: 06/04/2013 EXPIRES: 11/30/2013
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STATUS DATE: 06/0412013 APPLIED: 06/04/2013
SITE ADDRESS: 1024 PLEASANT ST, Springfield,OR 97477 SCOPE: Heating System
ASSESOR'S PARCEL NO: 1703264104800 TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: MEC-Dry Rot Repair-Kitchen
OWNER: SHAW CHRISTINA M Phone Number:
ADDRESS: 1024 PLEASANT ST
SPRINGFIELD OR 97477
CONTRACTOR INFORMATION
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
Mechanical Contractor DAVIS BROS GENERAL CONTRACTORS INC CCB 63275 04/06/2014 541-501-0877
General Contractor DAVIS BROS GENERAL CONTRACTORS INC CCB 63275 04/06/2014 541-501-0877
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.
n.
Owner or Contractor Signature Date
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Springfield Building Permit 6/4/2013 9:56:02AM Page 1 of 1
SPRINGFIELD CITY OF SPRINGFIELD
225 Fifth St
�`OkEGON TRANSACTION RECEIPT Springfield,OR 97477
541-726-3753
811-SPR2013-01151
www.springfield-or.gov 1024 PLEASANT ST permitcenter @springfield-or.gov
RECEIPT NO: 2013001104 RECORD NO:811-SPR2013-01151 DATE:06/04/2013
,"DESCRIP_TION_____ _ __�-_— � _ __ACCOUNT CODE/f-RANSiCODE 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•),_PAYMENTTYPE PAYOR CASHIER DBOWLSBY -,.COMMENTS' .;- - "��.`AMOUNT PAID
Check DAVIS BROS GENERAL CONTRACT( 93.60
5597 INC
TOTAL PAID: 93.60
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