HomeMy WebLinkAboutPermit Mechanical 2013-6-3 SPRINGFIELD ' 225 Fifth St
ha - CITY OF SPRINGFIELD Springfield,OR 97477
NPhoni
e: 541-726-3753
N,... 'OREGON Building / Residential Permit Inspection Phone: 541-726-3769
• Fax: 541-726-3676
PERMIT NO: 811-SPR201 3-01 1 45
www.springfieldor.gov permitcenter(ojspnngfield-ar.gov
PROJECT STATUS: Issued ISSUED: 06/03/2013 EXPIRES: 11/29/2013
STATUS DATE: 06/03/2013 APPLIED: 06/03/2013
SITE ADDRESS: 157 12TH ST,SPC#12,Springfield,OR 97477 SCOPE: Mechanical Only
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ASSESOR'S PARCEL NO: • 1703354100201 TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: Gas Line to Manuf.Home
OWNER: STIDHEM-DAVIS VENESSA DANN Phone Number:
ADDRESS: 205 GREEN LN SPACE 12
EUGENE OR 97404
CONTRACTOR INFORMATION
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
Mechanical Contractor C 8 R PLUMBING LLC CCB 167015 07/01/2014 541-736-9582
INSPECTIONS REQUIRED 1
Inspections
2300 Rough Mechanical Rough Mechanical: Prior to Cover
2999 Final Mechanical Final Mechanical: When all mechanical work is complete.
2170 Fuel Burning Appliance
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 w II be made of any structure without permission of the Community Services Division, Building Safety. I further
certify that on y ontractors and employees who are in compliance with ORS 701.005 will be used on this project. I further agree
to ensure•thai, II 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. - 1
/ i
O ner or Ed actor Sig ture Date
ATTENTION: q you to
follow rules adopted Oregon by law the reOregon uires Utility
NOTICE: Notification Center. Those rules are set forth
THIS PERMIT SHALL EXPIRE IF THE WORK In OAR 952-001.0010 through OAR 952-001-
AUTHORIZED UNDER THIS PERMIT IS NOT 0090. You may obtain copies of the rules by
rOMMENCED OR IS ABANDONED FOR calling the center. (Note: the teleph:.;.,;
number for the Oregon Utility Notification
"v I qn PAY PERIOD. Center is 1-800-332-2344).
Springfield Building Permit 6/3/2013 2:21:47PM Page 1 of 1
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SPRINGFIELD - CITY OF SPRINGFIELD
' 1 225 Fifth St
t TRANSACTION RECEIPT Spnngfield,OR97477
OREGON 541-726-3753
811-SPR2013-01145
www.springfield-or.gov 157 12TH ST. SPC 12 permitcenterespringield-or.gov
RECEIPT NO: 2013001093 RECORD NO:811 SPR2013-01145 DATE:06/03/2013
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DESCRIPTION .'r _ � � ��± k�x�: i.__, �r='�°ACGOUNTCODEIfRANS0Tol+l� :,',, „`,_;AMOUNT+DUE ':::
First Appliance Fee 224-00000-425604 1006 80.00
Gas Piping up to 4 outlets 224-00000-425604 1006 7.50
State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 10.50
Technology fee(5%of permit total) 100-00000-425605 2099 4.38
TOTAL DUE: 102.38
OF AYMENTnTYP.E WPAYOR cnsw' 'IaRSON. COMMENTS -. AMOUNTJPAID,:#-
Credit Card Richard Bays 102.38
247451
TOTAL PAID: 102.38
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Mechanical Permit Application , .cry,i,DEPARTMENT USE ONLY
.,r4,4tp)v,-,-..tti,n.nvnirtix4.,:fattvcc.74;itrvaticr,:34,,t;.4,t54:yci.rri.,1 SPRINGFIELD - —
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225 Fifth Street• Springfield,OR 97477 • PH(541)726-3753 • FAX(54I)726-3689 II, Date: 6773 // 3
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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.
IS,;,.;;it,•,:',4i:j2.:-,G4TEOOOY. OF'cONttiOctioN-j,,,y -itot.".:? ;:,:fsg..)-F1,y7C„cii:/:F.Es..:S'c, HEtiuL-E ix::•,-;:;-,?•:,,,,),•;:, •,..-7.;.::,•:•,.
afiesidential 0 Government ['Commercial Residential:4. e: 064.L,, ..,„ 4, 4.a Total v--
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.:)0B74SITE t. ' First Appliance $8000 $
Job site address: 1 57 t2 14-- cs 1.- 'Sick e I? Furnace/burner including ducts and vents
City: pt sGiA State: CAZ ZIP:91 -1Thi
OUp vo 10k BTUUh X- $ m. $
Reference: Taxlot.:
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'if;•C; i,••••';' 1,4;' ltiECIRIPTION or.VVORK:c ,,, , Heaters/stoves/vents 1,iitTi,?:efgz.; Unit heater / $18.50 $
1
y'61-CLIkikr.0 J
90-5
, i he ,i-o onasoi (C Wood/pellet/gas stove/flue $42.00 $
) Repair/alter/add to heating appliance/
refrigeration unit or cooling system/ $80.00 $
pl,,..„:„: :: 1 ,, ,,F?.R013,ERTY:;OWNEW4::Cr:;1,;!>,:>‘:::::,t1 :),qt", absorption system
Name; 577PRe744 -DnULS UENGSS 4- Evaporated cooler $14.50 $
Vent fan with one duct/appliance vent $10.00 $
Address: -M7--- 2c2c G rec.iA__L tn Le- /7._
Hood with exhaust and duct $.14.50 $
. City: &Ile-,e State: oic ZIP:
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) $4.5o $
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 $
n.CONTRACTOR:•INSTAI.LeATION,7;i:: .2"1:'',W Compressor/absorption system/heat pump
Up to 3 hp/100k BTU $18.50 $
Business name: C, 1 fa Pli , \\ nix b i n5
Up to 15 hp/500k BTU $32.00 $
Address: -13?3 7 Koci-VIT\I h Kite.
Up to 30 hp/1,000 BTU $47.50 $
City: „SQci yi9ce"-,I a\ State: a1?.. I ZIP: .7L47 5c- Up to 50 hp/1,750 BTU $62.50 $
Phone:9/1-C9I-M0 Fax: - Over 50 hp/1,750 BTU $104.50 $ •
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E-mail: ei_c e 1 im)i (cy___ rejlop 4, Le.,vt---A Incinerators
Domestic incinerator $22.50 $
CCB license no.: /6-D (5- ,c6iiIIOi:aial:"Yk:KIri4::,NPAr.‘"1.:4,;:).1;::::-ii \::::',',2•1-CV:tb.'1.1
Print name: Ric 60015 Enter total valuation of mechanical system
L„.. .e-- and installation costs$
Signature: (<161 c / c
Enter fee based on valuation of mechanical system,etc. $
c--
Allisaellailecusifees,;," , ,-- '--1-`21teins ' ,:.cl)st'4,,. ;,, :T0.01
, -,:-:., n • . '•'. ea,•4:-: ,-*7.cost,...,,1
Reinspection $80.00 $
. Specially requested inspections(per hr.) $80.00 $
Regulated equipment(unclassed) $14.50. $
Each additional inspection:(1) $80.00 $
l'•c)M.-.;":1!'.7:[;::.•:IP:tr?APPIIIOASItliBEV''.:;,,titfl;`!n:-,;V:.;':+;
(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): $ /OZ.?-6-