HomeMy WebLinkAboutPermit Mechanical 2013-11-7 I. 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-SPR2013-02476
www.springfieldor.gov - permitcenter @springfield-or.gov
PROJECT STATUS: Issued ISSUED: 11/07/2013 EXPIRES: 05/06/2014
STATUS DATE: 11/07/2013 APPLIED: 11/07/2013
SITE ADDRESS: 3807 E 21ST AVE, Eugene,OR 97403 SCOPE: Mechanical Only
ASSESOR'S PARCEL NO: 1803031202900 TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: Installing new woodstove
OWNER: MONROE SHARON V Phone Number: 541-687-9012
ADDRESS: 3807 E 21ST
EUGENE OR 97403
CONTRACTOR INFORMATION •
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
Mechanical Contractor ARTHUR MESMAN COB 191813 09/09/2014 541-337-2028
INSPECTIONS REQUIRED
Inspections •
2140 Pellet, Gas, Fireplace or Wood Wood Stove: After Installation.
Stove
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. .
Owner or Contractor Signature Date
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• • ATTENTION: Oregon law requires you to
follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth NOTICE: . '
in OAR 952-001-0010 through OAR 952-001- THIS PERMIT SHALL EXPIRE IF THE WORK
0090. You may obtain copies of the rules by AUTHORIZED UNDER THIS PERMIT IS NOT
-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).
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Springfield.Building Permit 11/7/2013. 12:15:52PM Page 1 of 1
Mechanical Permit Application DEPARTMENT USE ONLY
x' SPRINGFIELD _
-7s^ n : ° ::> i^-......- ..
CI ,OF �'PRINGFIE�LI7► OREGON t �f
T+I' Permit no.:0I ( ZoI 3 02.470
225 Fifth Street•Springfield,OR 97477 • PI1(541)726-3753 • FAX(54I)726-3689 : S
'-OREGON Date: //1243
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 ❑Commercial. Residential Qty. Cost Total
J ea. cost
JOB SITE INFORMATION AND LOCATION First Appliance $80.00 $
Job site address: 3801 L. awl- AN3c. Furnace/burner including ducts and vents
City: State' Up to I OOk BTUAv. - $18.50 $
y Euue ne o+2 ZIP:COL/03
Over 100k BTU/lir. $22.00 $
Reference: '1axlot.:
DESCRIPTION OF WORK Unit Heaters/stoves/vents
(� 1 Unit heater $18.50 $
1OS*Ca,,1 sib V e Wood/pellettas stove/flue / $42.00 $
Repair/alter/add to heating appliance/
refrigeration unit or cooling system/ $80.00 $
PROPERTY OWNER absorption system .
Name: `a‘n&con Monroe Evaporated cooler $14.50 $
Vent fan with one duet/appliance vent $10.00 $
Address: 3e0-7 k o a,\°it Aa e.
Hood with exhaust and duct $14.50 $
City: EusNene State:O ZIP:qOy03 Floor furnace including vent $80.00 $
Phone&'1I- 1 9011. I Fax: - - Gas piping
E-mail: hoc ckcnsse,cor'ICO.Si-.tn 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 CF/Y1 $12.00 $
Signature: #76-rttarp-ems Over 10,000 CFbd $22.00 $
CONTRACTOR INSTALLATION Compressor/absorption system/heat pump
Business name. Eire 1UC L� Pius Up to 3 hp/l OOk BTU $18.50 $
P O.( yx J"1 Up to 15 hp/500k BTU $32.00 $
Address: en oan J 1 Up to 30 hp/1.000 BTU $47.50 $
City: rU e ne I State:69„ I z1P:97 902 up to 50 hp/1,750 BTU $62.50 $
Phone] 1] Z.O c2 I Fax: - - Over 50 hp/1,750 BTU $104.50 $
E-mail: >, - aceSacvt @ n+ u _ ocs Incinerators
1q (811 Domestic incinerator $22.50 $
CCB license no.: 7 Commercial
Print name: Enter total valuation of mechanical system
and installation costs$
Signature:
Enter fee based on valuation of mechanical system.etc. $
• Miscellaneous fees Items Cost Total ea. cost
Reinspection 580.00 $
Specially requested inspections(per hr.) 580.00 $
Regulated equipment(unclassed) $14.50 $
Each additional inspection:(I) $80.00 $
APPLICANT USE
(A)Enter subtotal of above fees(or enter set l
minimum fee of $80_00) . $
(13)Investigative fee(equal to[A]) $
(C)Enter 12%surcharge(.12 x[A+B]) $
(D)Seismic fee, 1%(.01 x[A]) $
. (E)Technology Fee(5%of[A]) $
440-2545.1(4/t/2013/COMI) TOTAL fees and surcharges(A through E): $7-3 6. °. ,
24 a a s i S 4 t.-yi,U, 1 ry x j,5
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SPRINGFIELD- CITY OF SPRINGFIELD
TRANSACTION RECEIPT sP eld,OR97477
' OREGON 541-726-3753
811-SPR2013-02476
wwwspnngfield-or.gov 3807 E 21ST AVE permltcenter@spnngfield-ar.gov
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RECEIPT NO: 2013002459 RECORD NO: 811-SPR2013.02476 DATE: 11/07/2013
DC
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
.ems
�PAYMENTeTYPE'' _?PAYOR ��'.casHiER uuRSON �`:Ra COMMENTS AMOUNT;PAID IEIgµ
Credit Card Mandy Baumgardner 93.60
H51830
TOTAL PAID: 93.60
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