HomeMy WebLinkAboutPermit Mechanical 2013-6-25 SPRINGFIELD 225 Fifth St
it`� -' CITY OF SPRINGFIELD Springfield,OR 97477
C Phone: 541-726-3753
OREGON Building / Residential Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2013-01378
www.springfield-ar.gov permitcenter @springfield-or.goy
PROJECT STATUS: Issued ISSUED: 06/25/2013 EXPIRES: 12/21/2013
STATUS DATE: 06/25/2013 APPLIED: 06/25/2013
SITE ADDRESS: 217 S 70TH PL,Springfield,OR 97478 SCOPE: Mechanical Only
ASSESOR'S PARCEL NO: 1702353406402 TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: New HVAC mini split
OWNER: KEPHART RONALD G 8 MINDY A Phone Number:
ADDRESS: 2656 33RD ST
SPRINGFIELD OR 97477
_ CONTRACTOR INFORMATION
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
Mechanical Contractor KENT WITHAM AIR INC CCB 189283 01120/2014 541-543-6580
INSPECTIONS REQUIRED
Inspections
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 locatedy the front of the property, and the approved set of plans will remain on the site at all times during
construction.
/Owner or Con t cto Signature Date
ATTENTION: Oregon law requires you to
follow rules adopted by the Oregon Utility .J1'ICE:
Notification Center. Those rules are set forth ; HIS 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 COMMENCED OR IS ABANDONED FOR
calling the center. (Note: the teleph:::t;o
number for the Oregon Utility Notification ANY 180 DAY PERIOD.
Center is 1-800-332-2344).
Springfield Building Permit 6/25/2013 9:34:11AM Page 1 of 1
SPRINGFIELD CITY OF SPRINGFIELD
'f- 225 Fifth 5t
co OR TRANSACTION RECEIPT SpringrelefOR97477
541-726-3753
811-SPR2013-01378
www.springfield-or.gov 217 S 70TH PL permitcenter@springfield-ar.gov
RECEIPT NO: 2013001337 RECORD NO:811-SPR2013-01378 DATE:06/25/2013
[DESCRIPTION , +. .,;:A000UNT CODE/TRANS CODE'_, _: ' ,AMOUNT_DUE. i
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
PAYMENT TYPE
_ PAYOR_ CASHIER:.CCARPENTER - _F_COMMENTS ' ' AMOUNT:PAID r: i
Credit Card KENT WITHAM AIR INC 93.60
2236
TOTAL PAID: 93.60
Mechanical Permit Application DEPARTMENT USE ONLY ;
'" ' . v t .,....et. 7a,.; Permit no.: Sl3 — `771
eniVICI SPRINGFIELD,#OREGON i .
225 Fifth Street• Springfield,OR 97477 • PH(541)726-3753 ♦ FAX(541)726-3689 o._ • '7
! ,M1-,.�:., Date: �/z r/� /
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; OF CONSTRUCTION j-„' y x3> +r,rn"' .,. i "F,EE,SCHEDULE . "wti w
' r' r` t r' x.-- , a Total
❑Residential ❑Government ❑ Commercial ,,, First Appliance aI t.. .rt QtY rr r,ear "i !:>,„cost .
RestdenG
JOB!,SITEINFORMATIO,N; AND =LOCATIONr) ( $80.00 $ �v
Job site address: ) 11__ 5 70Th p L- Furnace/burner including ducts and vents
City: S� the;;1 e id_ I State: 0 P., I ZIP: 9 7y 7�S” Up to 100k BTU/hr. $18.50 $
Reference Taxlot Over 100k BTU/hr. $22.00 $
Heaters/stoves/vents
':°1.40 ESCRIPTION QF;WIORK4 i,-�, ' Unit heater $18.50 $
Tr�i on]( -tJUC T‘P 55 H eQ#PO rvkP Wood/pellet/gas stove/flue $42.00 $
Repair/alter/add to heating appliance/
refrigeration unit or cooling system/ $80.00 $
i 6C,„;&« h,):00, 051:Wl TYr;OWNER t `ri;:' �'s'� ,+l) absorption system
Name: IRO.\,-N. H-ePkq,C-\- Evaporated cooler $14.50 $
Address: 02 (� 51n 3's ' Vent fan with one duct/appliance vent $10.00 S.
c��7L,�7 Hood with exhaust and duct $14.50 $
City: 6[' F T . I State: O(Z I ZIP: ( ( 1 ( 7 . Floor furnace including vent $80.00 $
Phone: f 721-04/70 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 $
R- GONTRAcT,OR INST_ATLLATIO∎fritm` °`, yy 4 �v„- Compressor/absor tion system/heat pump .
/J Up to-3-hpil00k B $18.50 $
Business name: �Ke� cOt I,(A00,4 A_)-,(-
�p BO)C c75� I3pi p/l,000BU $32.00 $
Address: Up to 30 hp/1,000 BTU $47.50 $
City: SPED I State:O K I ZIP: 77Y 77 Up to 50 hp/1,750 BTU $62.50 $
Phone:52j[-Jo- 65--0 Fax6ta-636- Y926 Over 50 hp/1,750 BTU $104.50 $
E-mail: K(a)AI r 07 ae f{oftsio7 f . Con-I Incinerators ,
t�Q (513 Domestic incinerator $22.50 $
CCB license no.:
Commercial t4tY anifiggio ` , a h,yr `'fY
Print name: ke v\T / I AyVI Enter total valuation of mechanical system
and installation costs$
Signature. y r_�� a��- _ Enter fee based on valuation of mechanical system,etc. . $
- '.tre10„tti:4R. -ice wings eX u -Cost To"tar R''
sMiscellaneous fees: w r, +items -:t Y
�6.a--r :..mayss. __rr_ asMt?a A��tz ..- :'. -¢a v `cost :r
Reinspection $80.00 $
Specially requested inspections(per hr.) $80.00 $
Regulated equipment(unclassed) $14.50. $
Each additional inspection:(I) $80.00 $
fit &APPLICANTS:USE ,_iiIg „1*ig0
(A)Enter subtotal of above fees(or enter set
minimum fee of $80.00) $ YD
(B)Investigative fee(equal to[A]) $
(C)Enter 12%surcharge(.12 x[A+B]) $ @ 60
(D)Seismic fee, 1%(.01 x[A]) $ -
(E)Technology Fee(5%of[A]) $ L/O d
440-2545-J(4/1/2013/COM) TOTAL fees and surcharges(A through E): $ q3 6—g--