HomeMy WebLinkAboutPermit Mechanical 2013-6-21 SPRINGFIELD 225 Fifth St
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' CITY OF SPRINGFIELD Springfield,OR 97477
Phone: 541-726-3753--:
O0.6GON Building / Residential Permit Inspection Phone:541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2013-01353
viww.springfield-cr.gov permitcenterQspringfield-or.gov
PROJECT STATUS: Issued ISSUED: 06/21/2013 EXPIRES: 12/17/2013
STATUS DATE: 06/21/2013 APPLIED: 06/21/2013
SITE ADDRESS: 355 69TH PL,Springfield,OR 97478 SCOPE: Mechanical Only
ASSESOR'S PARCEL NO: 1702353200207 TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: Replace Heat Pump
OWNER: JOHNSON DAVID Phone Number:
ADDRESS: 355 69TH PL
SPRINGFIELD OR 97478
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 •
HENSON HEATING&AIR CONDITIONING LLC (CRE)Electrical C CRE96 541-367-5001
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 Contractor Signature Date
J`� _a
J - QUR FTENTION: Oregon law requires you to
s �'-' follow rules adopted by the Oregon Utility
•
yg5 -c9 - 1(Notification Center. Those rules are set forth NOTICE:
V°---- / In OAR 952-001-0010 through OAR 952-001-
0090. You may obtain copies of the rules by ' THIS PERMIT SHALL EXPIRE IF THE WORK
Calling the center. (Note: the telex'..., r, - AUTHORIZED UNDER THIS PERMIT IS NOT
number for the Oregon Utility Nn1lf,C,...,,irl COMMENCED OR IS ABANDONED FOR
Center is 1-000-33'2-23:`t). l,'Y 1 PO DAY PERIOD.
• •
Springfield Building Permit 6/21/2013 12:07:22PM Page 1 of 1
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SPRINGFIELD----- CITY OF SPRINGFIELD
r sl 225 Fifth St
` E�oN TRANSACTION RECEIPT Spnngfield,OR97477
541-726-3753
811-SPR2013-01353
www.spnngeeld-or.gov 355 69TH PL pernitcenter@spnngfield-or.gov
RECEIPT NO: 2013001310 RECORD NO:811-SPR2013-01353 DATE:06/21/2013
9i� italiolar >„ara,-, ,, ': 5 -SSt! kD° t2'_ACCOUNT:CODEPT NS.CODE Z:f.nt<::t •MOU it DUE F4
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
P.AYMENT-:TYP.E_- -n:J FAVOR-7 CASHIER:auesoN -f --'f= COMMENTS—leffeSORMSIOMMIPPNTIPAPAMEI.
Credit Card HENSON HEATING&AIR 93.60
020053 CONDITIONING LLC
TOTAL PAID: 93.60
Mechanical Permit Application DEPARTMENT USE ONLY
SPRI NGf IdL0•CI.Z'.t OF SI'itl,YGFIELDa ()IZF(,t`)N Permit i 811 zok3oi35 3
;25 Filth ytma . spnu6ndd,()R 91477 • Itl(541)726-375.1 • In\134 1)7 u1(rx0 IC=Y /
OMLGUM Dare. 6/Z/713.___. .--
This penult Is issued under OAR 918-.441)-0050. Permits expire if work is not starved within ISO days of Issuance or if work is
suspended for 180 days.
CATEGORY OF CONSTRUCTION I FEE SCHEDULE
Residential i ]Government (mnnenial Re8ldenllal Qty.
Ceo
Total
oust
JOB SI E INFORMATION AND LOCATION �I 41rv1.A)>pliance $8(A00 SVSd
Job silt address --- f urnxce/burner ine.ludin ducts and vet s
.,. `-�r F�� I Q T� ��u 17+w IQOk RIG/hr.
a r •
I L J . .._
City Stale lIP, gi 510.60 5 1
over 100k R fUlu. 522.0 $
Re[erten= faxlol . ----•--
..... ............_ ..__ ___.__..._..._ Healers/s wes/vents .
DESCRIPTION OF WORK
• lath hems $$4182.060 0 $kmT .».._ Luod/pte/ga stn eier
Repnu/allcitadd to beading appbuncc/
---- — nliigaratluu unit or cooling system/ $80.00
III
PROPERTY OWNER absorption system
t
Name i
, Evaporated enulcr $14.80
ce L_]1��......-.... .._
Address: _ e y"h' '' 2C..�. ..._____..__ith one duclleppllwtee sent $10,00
...... Wont tun w
- \ q� flood with exhaust and duel 514.60 S•City. € State: ( LIf�I}� U Moor hrrnaec including,end SBO.00 5
Phone 3-\. rL4 Fax Gas Linz
-
..E...--m—at M tow to tom nutters ( $7601
`.'.,.` Da �Wa —y T
Additional millets(each) .. (}f Sa.-O S
This rns(allatiot Is being mode n property owned by me or a ) mm�_.�-L._�.._
member of my immediate family. and is exempt from licensing Ai handlin u_nlls,inciii tit ducts
requirements under ORS 701.010 Up lo lOOMI(.f M j $12.00 S
Signature: Over I O 000 el:M $22.00 S .
CONTRACTOR INSTALLATION _Cnmpresserfabsnrptlnn system/heal urn '
` -- Vl �,I',.tl", Y - '-' — tip to i hp/I(IOk Rl l l $18.60 $
13 usiness naillC 'Ll11bA41.l.f.f �_ _......- ._._.__..,.......__.w.._..... ._._._ —..
L -- — Up u7 1 s hp1500k f)I U 532.00 $ _
Address: I 2_x9r'' L-� 's1 Qr. _ �.--�)_�j7_ Up l030 hp/1.000111t) $47.50 —.S
( rt _�I1.xth .EiCCY1c. I Sidle: 0 .. .—I /II):C1_.L..J-6.7:Ld. -..'____. _.hp/1.750 .....................,.__.,58250 S
-Phone:___- 5 `1—WI5=5�1c5 I Fax 5I-C- O `it Uvcr 50 iipii.l?O ill U 1104.60 $. .
Incinerators�coSc _h_Q ,ci. Y100. _
cal license no i 1% Domestic mrmendo _.., � ��$22.�_$
.._ .... ._ ' 1 ._....._..-.....-_ __. Commercial
I'nnl name:._ r m1,( h-} 1(' SOIL .— anuou,wl valuubon ohnechnmwlsslism
--- ..._.
_._ r_�(� -_— .. rvid mNUIIWiun onslx S __.__.___.....__..... ... ....._ __
NM
Signature: /-
F..n1u I.e hus`:d nn u,htauun of mechanic Jail s�slcm,Ue S
Miscellaneous fees (tens Cm( Total
Rcinspection __ $80.00 $
Specially requested inspection%(pia hr.) ___._._Tf$80.00 S
--
Regulated equipment(unelassed) ----• 514.60 5
tack additional inspection:(I I 580.00 $
___----APPLICANT USE
_
(A)Pinter subintul of above fees for enter set .,—_...._-......_..__,._..._._,.__
miolnm_m fee of b 60,04) $
(fs)In vesigarive tee(equal to IAD --- $
(C)Fri ter 12%surcharge(.12 x(A+I:%I) S
(D)Seismic:fee. I%(.01 x.(A)) ................--$
I Ed'technology f'ee15%nl'[Al) _, $
a10-2545•J(4'IaOIJ/eli^O TOTAL.fees and surcharges(A through E): -! ---i
( 7� -