HomeMy WebLinkAboutPermit Mechanical 2013-9-20 SPRINGFIELD 225 Fifth St
ti ° ` CITY OF SPRINGFIELD Springfield,OR 97477
!Ss Phone: 541-726-3753
�,OREGON Building / Residential Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2013-02126
www.springtield-or.gov permitcenter@springfield-or.gov
PROJECT STATUS: Issued ISSUED: 09/20/2013 • EXPIRES: 03/19/2014
STATUS DATE: 09/20/2013 APPLIED: 09/20/2013
SITE ADDRESS: 6822 F ST,Springfield, OR 97478 SCOPE: Mechanical Only
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ASSESOR'S PARCEL NO: 1702352201300 TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: Wood stove,1995
OWNER: DOTSON BRYAN&ELIZABETH Phone Number:
ADDRESS: 6822 F ST
SPRINGFIELD OR 97478
L CONTRACTOR INFORMATION
Contractor Type Contractor Name • Lic Type Lic No Lic Exp Phone
Mechanical Contractor OWNER CCB 000000 08/01/2025
INSPECTIONS REQUIRED
Inspections
2140 Pellet, Gas, Fireplace or Wood Wood Stove: After,Installation.
Stove
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 p sperty, and the approved set of plans will emain on the site at all times during
construction.
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,,i - 2 —20 l,
Owne o ontractor Signature Date
ATTENTION: Oregon law requires you to
follow rules adopted by the Oregon Utility
NOTICE: Notification Center. Those gh OAR 952f001-
THIS PERMIT SHALL EXPIRE W THE WORK in OAR 952-001-0010 throng
0090. You may obtain copies of the rules by
AUTHORIZED UNDER THIS PERMIT IS NOT calling the center. (on Util the Notrf cation•
COMMENCED OR IS ABANDONED FOR number for the Oregon
ANY 180 DAY PERIOD. Center is 1-800-332-2344).
Springfield Building Permit 9/20/2013 2'51:59PM Page 1 of 1
SPRINGFIELD CITY OF SPRINGFIELD
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lisa....((`` 225 Frftft St
` ``O OREGON TRANSACTION RECEIPT Springtield.OR 97477
541-726-3753
811-SPR2013-02126 -
www.springfield-or.gov 6822 F ST permitcenter @springfield-or.gov
RECEIPT NO: 2013002103 RECORD NO: 811-SPR2013-02126 DATE:09/20/2013
tDESCRIPTION _ __._ .;A000UNT CODEITRANS;CODE __=AMOUNT_DUE _s
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
AMOUNT PAID. - - -`
_PAYMENT TYPE-� PAYOR CASHIER:ccaRPeNreR-=_.,< : COMMENTS ,,��,; .. _ _.
Credit Card DOTSON BRYAN& ELIZABETH 93.60
36789z
TOTAL PAID: 93.60
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Mechanical Permit Application DEPARTMENT USE ONLY
,,� a F %, SPRINGFIELD 5�
, CITY}OESPRINGFIELD;QREG®N Permit no.: 2t 2-k
4^4 LAI
225 Fifth Street • Springfield,OR 97477 • 1'18540726-3753 • FAX(541)726-3689 At.o iooN Date:
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.
_�,.�f CATEGORY OF CONSTRUCTION FEE SCHEDULE
Lnljtesidential ❑Government ❑Commercial Residential Qty. Cost Total
J Pa. cost
JOB SITE INFORMATION AND (D LOCATION First Appliance $80.00 $ a'e
Job site address: G cR a F S 1- Furnace/burner including duets and vents
City:S c;ne PeW� State: d� ZIP: q 7 q7y Up to 100k BTU/hr. $18.50
P J Over 100k BTU/hr. $22.00 $
Reference: Taxlot.:
Heaters/stoves/vents _
DESCRIPTION OF WORK Unit heaver $18.50 $
ill 5-9//i -re ek.n p ?' V✓l rl f OVt Woo ' 9let/gas stove/flue $42.00 $
Repair/alter/add to heating appliance/
refrigeration unit or cooling system/ $80.00 $
TS PROPERTY OWNER absorption system
N
Name: 1'71 r w-1-s e,h/ Evaporated cooler $14.50 $
/ Vent lam with one duct/appliance vent $10.00 5
Address: b (2 a ±
7 1/7 Hood with exhaust and duct $14.50 $
City: /..v , Stated .0 ZIP. / Floor furnace including vent $80.00 $•
Phone:9g-WI" -Oba Fax: Gas piping
E-mail: dO-ff°mba&eV/ Co by...) One to four outlets ___ $7.50
This installation is being made on property owned by me or a _Additional outlets(each) $4.50 S
member of my immediate family, and is exempt from licensing Air-handling units, including ducts
requirements un ORS 7 .010. — Up to 10.000 CFb1 $12.00 S
Signature: 4 I OP a Over 1 0.000 CF61 - $22.00 S
CO r RACTO' INSTALLATION Compressor/absorption system/heat punjp
hit-7%-i_ Up to 3 hp!10(Ik 11'1'1_1 $18.50 $
Business name: — —
Up 10 15 hp/500k 13 rU $32.00 $
Address: Up to 30 hp/I,000 B'rU $47.50 $
City: Stale: ZIP: lip to 50 hp/1,750 BTIJ $62.50 $
Phone: - - Fax: - - Over 50 hp/I.750 BTU - 5104.50 $
F-mail: Incinerators _
-- -- — Domestic incinerator 522.50 I I
C,CI3 license no.: 1
Commercial
Print name: linter total valuation of mechanical system
and installation costs$
Signature:
Enter fee based on valuation of mechanical system.etc. S
Miscellaneous fees Items Cost Total ea. cost
Reinspection $80.00 $
Specially requested inspections(per hr.) $80.00 S
Regulated equipment(unel aased) $14.50 $
Each additional inspection:(1) -- - $80.00 $
• APPLICANT USE
(A)Enter subtotal of above fees(or enter set a O
minimum fee of S 80.00) $
(B)Investigative fee(equal to[Al) $
(C)Enter 12%surcharge(.12 s[A-FBI) $ G
ID)Seismic fee. 190(.01 x CAD $
(Ii)Technology Fee(5%of IAI) $ Y%
440.2545-J(411/2013/COM) "TOTAL fees and snrchaages(A through E): $93� .