HomeMy WebLinkAboutPermit Mechanical 2013-7-3 SPRINGFIELD 225 Fifth St
CITY OF SPRINGFIELD Springfield,OR 97477
• Phone: 541-726-3753
OREGON Building / Residential Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2013-01529
www.springfieldar.gov permitcenter @springfeld-or.gov
PROJECT STATUS: Issued ISSUED: 07/03/2013 EXPIRES: 12/29/2013
STATUS DATE: 07/03/2013 APPLIED: 07/03/2013 •
SITE ADDRESS: 1436.SE000IA AVE,Springfield,OR 97477 SCOPE: Mechanical Only
ASSESOR'S PARCEL NO: 1703273309100 TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: Bathroom exhaust fan
OWNER: MYERS TERESA L Phone Number:
ADDRESS: 1342 CENTENNIAL BLVD
SPRINGFIELD OR 97477
CONTRACTOR INFORMATION
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
Mechanical Contractor OWNER CCB 000000 08/01/2025
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. p
i�- , 7/373 •
Owner or Contractor Signatu �_ Date
ATTENTION: Oregon law requires you to
'00IH3d 1�V0 081- Ai': follow rules adopted by the Oregon Utility
11O1 03NOONV8V SI HO 03ON3WWO . Notification Center. Those rules are 52 001
in OAR 952-001-0010 through OAR 952-001-
- ION SI lMMfl3d SIH1 H30Nf1 03ZIHOHlflV 0090. You may obtain copies of the rules by
1a0M 3H1 di 311IdX3 11VHS 1111183d SI H1 calling the center. (Note: the teleph r o
:301.1.0N Center for the Oregon Utility Notification.
Center is 1-800-332-2344).
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Springfield Building Permit 7/3/2013 10:18:18AM Page 1 of 1
SPRINGFIELD--._ CITY OF SPRINGFIELD 225 Fifth St
TRANSACTION RECEIPT Spring eld,OR97477
Et'\ 541-726-3753
OREGON 811-SPR2013-01529
www.springfieldor.gov 1436 SEQUOIA AVE pennitcenter@springfield-ar.gov
RECEIPT NO: 2013001434 - RECORD NO:811SPR2013-01529 DATE:07/03/2013
DESCRIPTION „shj . thtan=_'t' 2 C j t?'_'ACCOUNT,CODETFRANS CODE iL?i k,1-AMOUNT.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
P-AYMEWITY„E "PA ellre xie`mril cAaeeri7ER COMMENTS ;aAMPPItgt,AID F. i
Credit Card MYERS TERESA L 93.60
215148
TOTAL PAID: 93.60
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- Mechanical Permit Application DEPARTMENT,USE ONLY::!-=-
j a„ y wtgigtr apra 'y . � � SRNGED a vIT,XO�CP RINGFIEED, REGON " •
Permit no S/7—l c-2-
ekR.;.,: ,w.IS »'-,..ICan ..„„afi,:—.2:„T3..... ;, .i'1tw n a /� '7
225 Fifth Street• Springfield,OR 97477 • PH(541)726-3753 • FAX(541)726-3689 ,- Date: //J//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. -
nGEITEGORYtOFt,CONSTRUGTION( . :;[ ',k „s 4 t=4„ '' EE SCHEDULE °s
Residential E Government ❑ Commercial R sidential 3 Cost Total
_�. �s _ ,-. ,� o ;, Q[Y r.^'^ea �”",cost .',
JOB,aSITE INFORMATION;"ANDtLOC TION: ;i First Appliance / $80.00 $ 0
Job site address: /4/36 5;1110 yCI 1 ✓ ' Furnace/burner including ducts and vents
City:_.; 4 6*,
Ste:de ZIP:77y77 Up to l00k BTU hr. $18.50 $
/ Over look BTU/hr. $22.00 $
Reference: Taxlot Heaters/stoves/vents
s 1rxa :1E. CRPTON . WORK '4 h;r r Unit heater
,e $18.50 $
YYY jr4f2QOM n Wood/pellet/gas stove/flue $42.00 $
Repair/alter/add to heating appliance/
h refrigeration unit or cooling system/ $80.00 $
i;a,u'i`t y u� ln� kPROPERT+YpOWNER�At t ri, , nRSt. absorption system
Name: 4.-rlr,, erf Evaporated cooler $14.50 $
/G/�� cb
7 Vent fan with one duct/appliance vent / $10.00 $ O
Address: ✓` �/
/ B Hood with exhaust and duct $14.50 $
City:57'h- �c�� Stater,/` ZIP: 171/77 - Floor furnace including vent $80.00 $
Phone,'/7$76G,S 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 un 01 01 Up to 10,000 CFM $12.00 $
Signature / : Over 10,000 CFM $22.00 $
F` 1 EONTRACTOR INSAII ON Yg7, �`"x 'w" ' Compressor/absorption system/heat pump
Up to 3 hp/100k BTU $18.50 $
Business name/72.-I/1./V2— Up to 15 hp/500k BTU $32.00 $
Address: - Up to 30 hp/1,000 BTU $47.50 $
' City: State: ZIP: Up to 50 hp/1,750 BTU $62.50 $
Phone: - - Fax: - - Over 50 hp/1,750 BTU $104.50 $
E-mail: Incinerators
Domestic incinerator $22.50 $
CCB license no.:
Print name: Enter total valuation of mechanical system
and installation costs$
Signature: Enter fee based on valuation of mechanical system,etc. $
�:Miscellan ous fees' . i' Items s Cost Total1t
.� - 9.:1”2rKv1 ,> . 4..-,ea cost
Reinspection $80.00 $
Specially requested inspections(per hr.) $80.00 $
�P
LL � Regulated equipment(unclassed) $14.50. $.
um l�r S7 Each additional inspection:(1) $80.00 $
'C r 4 'APPLICANT USE aka*';`.t%
(A)Enter subtotal of above fees(or enter set
r sv /f , minimum fee of $80.00) $ OPO
(B)Investigative fee(equal to[A]) . $
(C)Enter 12%surcharge(.12 x[A+B]) $ 5'Go
(D)Seismic fee, 1%(.01 x[A]) $
(E)Technology Fee(5%of[A]) $ rf OO
440-2545-1(4/12013/COM) TOTAL fees and surcharges(A through E): $ 97 a
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