HomeMy WebLinkAboutPermit Mechanical 2013-5-29 SPRINGFIELD 225 Fifth St
Att
CITY OF SPRINGFIELD Springfield,OR97477
• Phone: 541-726-3753
OREGON Building / Residential Permit Inspection Phone: 541-726-3769
•
Fax: 541-726-3676
PERMIT NO: 811-SPR2013-01082
w v.springfieldor.gov - permitcenterCa)springfield-or_gov
PROJECT STATUS: . Issued ISSUED: 05/29/2013 EXPIRES: 11/24/2013
STATUS DATE: 05/29/2013 APPLIED: 05/29/2013
SITE ADDRESS: 776 V ST,Springfield,OR 97477 SCOPE: Mechanical Only
ASSESOR'S PARCEL NO: 1703261201503 TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: Replace Gas Furnace
OWNER: CROSSWHITE CURTIS C Phone Number:
ADDRESS: 776 V ST
SPRINGFIELD OR 97477
L. CONTRACTOR INFORMATION
Contractor Type Contractor Name Lic Type • Lic No Lic Exp Phone
Mechanical Contractor HENSON HEATING&AIR CONDITIONING LLC GCB 198782 01/23/2015 541-367-5001
INSPECTIONS REQUIRED III
Inspections
2170 Fuel Burning Appliance
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 Contractor Signature " Date
pa,„- e`"- Y z.
rL "'
fern-,
911 ATTENTION: Oregon law requires you to
follow rules adopted by the Oregon Utility
Notification Center. Those rules OAR 952-001-
et forth
H oAR 952-001-0010 through O the rules by
NOTICE: p;90. You may obtain cop
l„1 ling the center. (Note: the telepht
THIS PERMIT SHALL EXPIRE IF THE WORK I,t, nl9r for the Oregon Utility Notification
AUTHORIZED UNDER THIS PERMIT IS NO Center is 1.800-332- .344).
nOMMENCED OR IS ABAN ONIEf r-n'-
r.n rm! r DJ'.r .
Springfield Building Permit 5/29/2013 9:23:58AM Page 1 of 1
SPRINGFIELD smolt CITY OF SPRINGFIELD
225 Fifth St
,OREGON TRANSACTION RECEIPT 5pringfield,OR97477
541-726-3753
811-SPR2013-01082
www.spnngfield-or.gov 776 V ST permitcenterc@springfield-or.gov
RECEIPT NO: 2013001048 RECORD NO:811-SPR2013-01082 DATE:05/29/2013
(o1 .Yoldl:dd[ol:dTilL111 4,?a4,a`' -1 _", d ` ...s. all ^ACCOUNT CODE/TRANS GODSalli"h lei.ANIOUNT 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
1AY,MENT1WEE P,AYOR CASHIER:.JLARSON ... :COMMENTS AMOUNT,LPa
Credit Card HENSON HEATING&AIR 9160
091505 CONDITIONING LLC
TOTAL PAID: 93.60
•
Mechanical Permit Application • DEPARTMENT USE OILY
.....r[KG aaawtierq
CITY OF SPRINGFIELD., OI2EGON ji,pt„ Permit no.Rll Z013 0IOBZ
225 Filth Street •Springfield,OR 97477 • P11(541)726-3753 • FA%1541)726.)689 dirilli Date: S-71 9h
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. .
f ' 'CATEGOPt OF'•`CONSTRUCTION .. . FEE•�SCNEDULE • • '
1� Residential ❑Government ❑Commercial RbsldbnOgl ,., Qty o o �
JOB SITE INFORMATION AND LOCATION: First Appliance l $79.00 5 _
Job sitite���addresss(:, W V Furnace/burner including ducts and vents
City A06 State: ZIP:Cr 4n LIP to I110k BTU/hr. l $17.00 $ no
-Jt-
Over IOOk RTU/hr. 820.00 S
Subdivisiuu: Lot no.:
Heaters/stoves/vents _
PE$C PT10N OF. WORK Unit hwter --
$17.00 $
� Q r1 larcz.. _ Wood/pellet/gas stove/flue $38.00 $
• Repair/alter/add to heating appliance/
refrigeration unit or cooling system/ $68.00 $ .
PROPERRTY�a OWNER absorption system
Naine:A & Crt . 3,'(\-t — Evaporated cooler $13.00 S
t _ Vent fan with one duct/appliance vent $9.00 $
Address' C7t'
r� ' � Hood with exhaust and duct $13.00 $
City; TOT'
tate:Q r Z1P: 111 { I"] Floor furnace including vent $68.00 S
Phone:(jot�� �%kp, Fax: - - Caspiping
E-mail:yvt ands sthe ,(1 "ls l [1lsl\ ,GbM One to four outlets $7.00 $
This installation is being made on properVY owned by me or a Additional outlets(each) $4.00 $
member of my immediate family, and is exempt from licensing Air-handling units,including ducts
requirements under ORS 701.010. Up to 10.000 CF1.1 $11.00 $
Signature: Over 10,000 CFM $20.00 $
.. CONTRACTOR•INSTALLATION' Compressor/absorption system/heat pump •
,t /C., Up to 3 hp/100k BTU $17.00 $
Business name: X�p(\ �& }'t
Q `I, � A Up to 15 hp/500k BTU $20.00 b
Address: (ZZ 1 LLt AA_ Up to 30 hp/1 000 BTU $43.00 $
City5(4- \-i, Stale: Qtr Z1P S%lp Up to 50 hp/1,750 BTU $67.00 $
Phone:5 A.-3Io1-5t33-\ LFax:5L -t-at nap Over 50 hp/1.750 BTU ' $95.00 $
E-mail:VAPn akrILC Ato 6)laoltba e�SY�
incinerators __-�
`� `rinpp p JJ Domestic incinerator
520.00 S
CCB license no.: L'10,� •• . . .., :.: .,,. ..
Committal
Print name: �� Enter total valuation of'mechanical system
and installation costs S
signature: /� � _ Enter 2e based on valuation of mechanical system,etc. $ •
//J Mlsobllaneoue t905 I.:,.. 1 liens ¶ t Tathl-.
Reinspection $58.00 $
Specially requested inspections(per hr.) SSB.00 S
s
Regulated equipment(unclassed) $13.00 $ •
Each additional Inspection:(I) $58.00 $
y:�:. v. ,ems. Y� u
(A)Enter subtotal of above fees(or enter act
minimum fee of S ZLa) $
(R)Investigative fee(equal to[A]) $
(C)Enter 12%surcharge(.12 x[A+B]) S
(A)Seismic fee, I%(.01 x[A]) S
(F.)Technology Fee(5%of[A]) $
440-2545-ill I/ox/COM) TOTAL fees and surcharges(A through E): 51