HomeMy WebLinkAboutPermit Mechanical 2013-8-9 SPRINGFIELD 225 Fifth St
CITY OF SPRINGFIELD Springfield,OR 97477
" Phone: 541-726-3753
OREGON Building / Commercial Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2013-01782
www.springfield-or.gov • permitcenter @springfield-or.gov
PROJECT STATUS: Issued ISSUED: 08/09/2013 EXPIRES: 02/04/2014
STATUS DATE: 08/09/2013 APPLIED: 08/09/2013 •
SITE ADDRESS: 1630 12TH ST,Springfield,OR 97477 SCOPE: Mechanical Only
ASSESOR'S PARCEL NO: 1703264110800 TYPE OF STRUCTURE: Commercial
PROJECT DESCRIPTION: Replace oil boiler with gas boiler •
OWNER: OF SEVENTH DAY ADVENTISTS Phone Number:
ADDRESS: 605 SE 39TH AVE •
PORTLAND OR 97214
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OWNER: WEST ORE CONFERENCE ASSOC Phone Number
ADDRESS: 605 SE 39TH AVE
PORTLAND OR 97214
CONTRACTOR INFORMATION
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
Mechanical Contractor COMMERCIAL AIR INC CCB 110075 12/18/2013 541-461-4821
INSPECTIONS REQUIRED h
Inspections
2255 Gas Pressure Test
2300 Rough Mechanical Rough Mechanical: Prior to Cover
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.
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.
AT�f ENTIc ^e -gon law requires you to
'.c ^a the Oregon Utility 8/7 /; •
Owner or Contr4dt9tiBt'gtutull&enter. Those rules are set forth Date -
in OAR 952-001-0010 through OAR 952-001- NOTICE:
0090. You may obtain copies of the rules by THIS PERMIT SHALL EXPIRE IF THE WORK
• calling the center. (Note: the teleph::r,,, IS
number for the Oregon Utility Notification
Center is 1-800-332-2344). COMMENCED OR ABANDONED FOR
\NY 180 DAY PERIOD.
Springfield Building Permit 8/9/2013 10:53:25AM Page 1 of 1
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SPRINGFIELD CITY OF SPRINGFIELD
225 Fifth St
TRANSACTION RECEIPT Springfield,OR 97477
541-726-3753
OREGON 811-SPR2013-01782
www.springfeldor.gov 1630 12TH ST permitcenter @springfield-or.gov
RECEIPT NO: 2013001735 RECORD NO:811-SPR2013-01782 DATE:08/09/2013
��,,'AGGOUNTCODETTRANS.CODE=si-IefE VAMOUNT it
Mechanical Permit fee(based on value of work) 224-00000-425604 1006 296.84
State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 35.62
Technology fee(5%of permit total) 100-00000-425605 2099 14.84
TOTAL DUE: 347.30
FAYMEFItitYP.E . I ORticdsw@at*cc lore t=R= „ COMMENTS AMOUNT.PAID
Credit Card COMMERCIAL AIR INC 347.30
05059g
TOTAL PAID: 347.30
g i Roe, e PSs6-
Fc g CL-7.it 6903 . 3 ( 2 ) Sic = (, /,2- &Al
Ayers red c�s.
Pp-ens Soo etA1.
Pre' to hre-ee 4. W c.0 S-c-6 Wl-e-Peci In S i
(.jt"A (fro C.I U eIy-eit 1(P,-6_EFle Go Imo/ ' Nori 2m,.^l" -5 _
of f5-f l-6-r-,Zn -Pc(J_✓ 1 V (/'-f-&X Jry yo ko;,Lt.� /',21.P
I/-_1 pe:,
m
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—t_
,e
ms.s;�•r:e Request for Boiler/Pressure Vessel Permit Mail payment to:
y
;;;; -'7=tai G� DCBS Box 16 .Services
�e-,n�� . for Installation, Alteration, or Repair P.O.Box 14610
`'+`�� Department of Consumer and Business Services Salem,OR 97309-0445
r}' Building Codes Division•Boiler Section EPARTMENT)USEg NLSY,
1535 Edgewater NW,Salem,OR Permit no.:
Mailing address:P.O.Box 14470,Salem,OR 97309-0404
503-373-7538;Fax:503-378-4101 ❑Accepted ❑Denied
Web:bcd.oregon.gov Date: By:
;.- . APPL^ICANT_INFORMATION" u, ',°��Y - .r,.g;t_._
Applicant's business name: (iJ�/r+e./`C/at ( 1 l i r _hC -
Address 1: /6615 JJ11 ,'ylJp I Address 2:
City: Fenn pLP 1 State: �/e ZI : 7 a
„Z
Phone:5$/ - y6/ - qt./ J Fax:S L - 416/
-E w Li- E-mail:
Boiler/pressure vessel contractor business license no:: //00 75 •
Construction Contractors Board registration no.: 1/007,5 0 stamp no.:
List names and Oregon license numbers below of all Class 1 through Class 6 mechanics who will perform work on this project.
(Attach additional sheets,if necessary.)
Name License number
�O S30Z . CL3
4,,... PO e (et Nc -370 CL 3
/Yh /te parry 5/53 (1 3
AMEISSLAMSCIWNEWBSEFOINE0 MATIONta
Owner's name 5/ol;n field 771 a,/Advont lir j:mirt`A I Phone:S44/ •.521 -cL51,3
Address and vessel location: /6'30 /J t4 S`/--
City Spr,•12 t/d i ZIP:974L77 Commercial ❑Residential
v,_:._.._. .:: _ .,.;:.._ _., . INSTArLL'ATIQN;SAL`^7'ERATION !?ORAREPAIRIINFORI!lAT10N.:..:;rg° gamEg ,,,„.,_:.;;„;;,:
Check all that apply.(If altered,submit drawings/calculations.)
Type of work: VI Boiler ❑ Pressure vessel ❑ Beverage service tank Job start date:5-7:22.1)(3
®Install ❑p;Repair ❑ Alter ❑ Weld g']Non-weld
Description of vessel: S U S001( r /6 t L1,4 t e,„- ( Ir tee-- I NB/State number:426 ?L i.-
Size and length of piping: /j1/' Liss L44,4.I
Describe nature of work attach additional sheets if necessary): •2- nem 4 /j/(t...- gor/. r-
/(9o4e r7L a % gam-/-/47.-C _ g-S o2. 3
Applicants name(print): Signature: Date:
Fiscal code Surcharge code Total each
Q Boiler $175 70311/1195 plus 12%surcharge= $21 70311/1291 $ 196.00
❑Pressure vessel $125 70311/1195 plus 12%surcharge= $15 70311/1291 $ 140.00
❑Beverage service tank,over 5 cubic feet in volume $50 70311/1195 plus 12%surcharge= $6 70311/1291 $56.00
Permit fees are nonrefundable.
-2333 Make check or money order payable to Department of
If 1 urination box. Consumer and Business Services.Do not send cash.
' 1/-1 3 DCBS FISCAL USE ONLY
T I
Ilion date
flaunt
440-: Page 1
i.
'Mechanical Permit Application DEPARTMENT USE ONLY
SPRINGFIELD /712
CITY OF SPRINGFIELD, OREGON ''' I Permit no.: S/3 -/712-
/ L
225 Fifth Street•Springfield,OR 97477• PII(541)726-3753 • FAX(541)726-3689 * Date: �/ / /13
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 FEE SCHEDULE: -
❑Residential ❑Government ommercial -Residential- - Qty Cost Total
ea. cost
JOB SITE INFORMATION AND LOCATION First Appliance $79.00 $
Job site address: /n'7.6 A//,. `(1- Furnace/burner including ducts and vents
City:5t/J4'Inf 'E- State:e* ZIP:97y77 Up to 100k BTU/hr. $17.00 $
�'" Over 100k BTU/hr. $20.00 $
Reference: Taxlot.:
H eaters/stoves/vents
DESCRIPTION OF WORK. Unit heater $17.00 $
Peek f2 p I t( . re el J o7te/ 0.) I. 6"4-g Wood/pellet/gas stove/flue $38.00 S
Fe d bA�v„ Ne S Y"e ,y, -i"✓ Repair/alter/add to heating appliance/
( GG"". P- refrigeration unit or cooling system/ $58.00 $
C PROPERTY OWNER �/ absorption system
Name: J ietivtq rek i a ye CI P O rtgrS / Evaporated cooler $13.00 $
Address: t 6, X7 // ( a-I-A- / Vent fan with one duct/appliance vent $9.00 $
^ �,,,p Hood with exhaust and duct $13.00 $
City: f t ad State: V le ZIP:T7'I7 7 Floor furnace including vent $58.00 $
Phone: 1�t -.0151 .3 Fax: - x/724- Gas piping
E-mail: 1, .614 US g Tuwo . (e Wl One to four outlets ..Z $7.00 $
This installation is being made on property 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 CFM $11.00 $
Signature: Over 10,000 CFM $20.00 $
CONTRACTOR INSTALLATION • Compressor/absorption system/heat pump
Business name: I A Up to 3 hp/100k BTU $17.00 $
tM vvterc�n tV �s^L Up to 15 hp/500k BTU $29.00 $
Address: ' le.G,C XY/'t{ L. w, (Q� Up to 30 hp/1,000 BTU $43.00 $
City: C6.1 ,,, State: Q}Q I ZIP:g74re . Up to 50 hp/1,750 BTU $57.00 $
Phone:39\--441- II 82 ( I Fax:Syt- la 4,/o ei Over 50 hp/1,750 BTU $95.00 $
E-mail: aph. e C Otxvvt O r . b r',2.._
Incinerators
Domestic incinerator $20.00 $
CCB license no.: //067sr .. -".
� p - Commercial
T� _. ., -. . ... ...,.,_. ,
Print name: Da IA. ?)rr Enter total valuation of mechanical system co
�l �� and installation costs$
Signature: �.�!/ Enter fee based on valuation of mechanical system,etc. $
l l Per 1 T p�I�df �y Miscellaneous fees = terns Cost _ Total :;
l r �� I
Rcinspcction $58.00 $
..Yt q_ee 0-F &4-C3ov• t Specially requested inspections(per hr.) $58.00 $
Regulated equipment(unclassed) $13.00 $
Each additional inspection:(I) $58.00 $
]$ APPLICANT;USE --:
(A)Enter subtotal of above fees(or enter set 74
minimum fee of $79.00) $S -----
(B)Investigative fee(equal to[A]) $
(C)Enter 12%surcharge(.12 x[A+B]) $ f 2
(D)Seismic fee, 1%(.01 x[A]) $
(E)Technology Fee(5%of[A]) $ /y
440-2545-1(11/08/COM) TOTAL fees and surcharges(A through E): -`-.1C/%724)