HomeMy WebLinkAboutPermit Mechanical 2013-6-26 SPRINGFIELD 225 Fifth St
it` ' CITY OF SPRINGFIELD Springfeld,OR 97477
r`
°O v Phone: 541-726-3753
OREGON N Building I Commercial Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2013-01406
www.springtield-or.gov permitcenter@springfield-or.gov
PROJECT STATUS: Issued ISSUED: 06/26/2013 EXPIRES: 12/22/2013
STATUS DATE: 06/26/2013 APPLIED: 06/26/2013
SITE ADDRESS: 999 5 A ST,Springfield,OR 97477 SCOPE: Mechanical Only
ASSESOR'S PARCEL NO: 1703354109200 TYPE OF STRUCTURE: Commercial
PROJECT DESCRIPTION: Gas piping-5Lb pressure
OWNER: R-H MCKENZIE COMPANY LLC Phone Number:
ADDRESS: PO BOX 2280
EUGENE OR 97402
CONTRACTOR INFORMATION
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
Mechanical Contractor AMBASSADOR PIPING INC CCB 121469 03/27/2015 541-726-5723
INSPECTIONS REQUIRED
Inspections
2255 Gas Pressure Test
2310 Rough Gas Rough Gas: After line is installed and required testing and capped if not attached to
an appliance.
2995 Final Gas Final Gas: When all gas 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 o ,of the property, and the approved set of plans will remain on the site at all times during
construction.
Owner or Contra • Signature Date
ATTENTION: Oregon law requires you to
. follow rules adopted by the Oregon 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
calling the center. (Note: the telephone COMMENCED OR IS ABANDONED FOR
number for the Oregon Utility Notification ANY 180 DAY PERIOD.
Center is 1-800-332-2344).
Springfield Building Permit 6/26/2013 2:37:28PM Page 1 of 1
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SPRINGFIELD CITY OF SPRINGFIELD
:1 C
`O EGON TRANSACTION RECEIPT 225 Fifth R
Springfiel dOR97477
541-726-3753
811-S PR2013-01406
www.springfield-or.gov 999 S A ST pennitcenter @springfield-or.gov
RECEIPT NO: 2013001357 RECORD NO: 811-SPR2013-01406 DATE:06/26/2013
DESCRIPTION __w` "_ACCOUNT.CODE/TRANSC.ODE__ _AMOUNTDUEY.
Mechanical Permit fee(based on value of work) 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
LPAYMENT TYPE, . PAYOR - CASHIER:CCARPERiER . . COMMENTS - • -' AMOUNT PAID _ -
Credit Card Charles Coury 93.60
045063
TOTAL PAID: 93.60
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Mechanical Permit Application DEPARTMENT,USE ONLY -c--
.y W' P ` �Witi h¢:nry� SPRINGFIELD .2'm+cw (�•1WM.keE1 �1' SPRINGEIELY3D:FORE i = ` ». . Permit no.: S�3 -- '&i
., ..,> `�- an.�,._.,$t..Ememr aw..aa:G,�trcm' - x. 'aa e -
�225 Fifth Street♦ Springfield,OR 97477 ♦ PH(541)726-3753 ♦ FAX(541)726-3689 ,2tiet,, Date: 0724//3
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.
=( CATEGORYr OAICONSTRUCTION , , ` i tFEE CSCHEDULE;} a`
1R: srde nia i 3 Mn a Q' ? Ceoa t ..;eTcoota_l
c❑Residential ❑Government Commercial
JOB;;SITE INFORMATION'"AN_D (LOCATION r- First Appliance $80.00 $
Job site address: qgq 3 ep.,41'1 4 - rider`' Furnace/burner including ducts and vents
City 4bYiy V,e1A I State: fl ZIP g74/7� Up tol00kBTUhr. $18.50 $ _
[ Over 100k BTU/hr. $22.00 $.
Reference /76,-j �S'eirt Taxlot D22_0a Heaters/stoves/vents
.:*-1,---,'DESCRIPTION;]OFD WORK;;t r „K-�, ;'.. Unit heater $18.50 $
A,q'' zired c(745 Wpr 0/.3+4/l Wood/pellet/gas stove/flue $42.00 $
Repair/alter/add to heating appliance/
refrigeration unit or cooling system/ $80.00 $
` '' _ t, ;PROPERTYt'OWNER {ii'?„ `4 rl"i'`__ -: absorption system
Name: —4- A( Ye n7/e rar71 0flV / /-c Evaporated cooler • $14.50 $
Address: �� 2 Z 1 Vent fan with one duct/appliance vent $10.00 $
. Hood with exhaust and duct $14.50 $
City: Cu oh (L e State: a ZIP:9-Noe 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,/ d is exempt from licensing Air-handling units, including ducts
requirements under ORS 7!1.1 re Up to 10,000 CFM $12.00 $
r Signature:7,..d....1 r Over 10,000 CFM $22.00 $
F*-l=`" ` cdbNTRACT4 4INSTALLATIOe�,1M Compressor/absorption system/heat pump
Business name: 4, 665 p1
. e 0C M -Avl Up to 3 hp/look BTU $18.50 $
1 Up to 15 hp/500k BTU $32.00 $
Address: Ao ye 7o -3 2 Up to 30 hp/1,000 BTU $47.50 $
City: ,/°�L/) State: � ZIP: �y7S Up to 50 hp/1,750 BTU $62.50 $
Phone: 72.-c 72 3 Fax: - - Over 50 hp/1,750 BTU $104.50 $
E-mail: Incinerators
Domestic incinerator $22.50 $
CCB license no.: 7/ tic C� ,../ x,:Commercial°.y'��i�"��,�`�"�.,)'FS'(iFa `&-rrta`,, .. .,`?>;N,`
Print name: Enter total valuation of meth nical system
and installation costs$ /9 00
Signature:
Enter fee based on valuation of mechanical system,etc. . $ TO
tt
<Mtscellafeo e . vgen Prig `p +
neous feesr 1 ;Items -;Cost Total
Reinspection $80.00 $
Specially requested inspections(per hr.) $80.00 $
Regulated equipment(unclassed) $14.50. $
Each additional inspection:(I) $80.00 $
r:4111 ` 'APIPLICANT SE 1 aK, ri
(A)Enter subtotal of above fees(or enter set J
minimum fee of $80.00) $ 20
(B)Investigative fee(equal to[A]) $
(C)Enter 12%surcharge(.12 x[A+B]) $ q4,0.
(D)Seismic fee, 1%(.01 x [A]) $
(E)Technology Fee(5%of[A]) $ (/00
440-2545-J(4/1/2013/COM) TOTAL fees and surcharges(A through E): $ c/ 36
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