HomeMy WebLinkAboutPermit Mechanical 2013-11-4 •
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-SPR2013-02438
www.springfield-or.gov permitcenter@springfield-or.gov
PROJECT STATUS: Issued ISSUED: 11/04/2013 EXPIRES: 05/03/2014
STATUS DATE: 11/04/2013 APPLIED: 11/04/2013
SITE ADDRESS: 529 W CENTENNIAL BLVD,Springfield,OR 97477 SCOPE: Mechanical Only
ASSESOR'S PARCEL NO: 1703274305805 TYPE OF STRUCTURE: Commercial
PROJECT DESCRIPTION: Line for Gas Range
OWNER: CENTENNIAL SHOPPING CNTR LLC Phone Number:
ADDRESS: 7831 SE STARK ST STE 103
PORTLAND OR 97215 •
CONTRACTOR INFORMATION
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
Plumbing Contractor SUSAN JANE ARNOLD GCB .49561 12/16/2014 541-484-3787
L INSPECTIONS REQUIRED.
Inspections
2250 Gas Piping
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 'ontractor Signature Date
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Springfield Building Permit 11/4/2013 9:24:42AM Page 1 of 1
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SPRINGFIELD '-- CITY OF SPRINGFIELD
• 225 Fifth St
&EGO.N TRANSACTION RECEIPT Springfeld.OR97477
541-726-3753
811-SPR2013-02438
www.springfield-ar.gov 529 W CENTENNIAL BLVD permitcenter@spdngfield-or.gov
RECEIPT NO: 2013002415 RECORD NO:811SPR2013-02438 -r: DATE: 11/04/2013
Je]�.3o1:J�:htllol:l a.s_ a;. 6 `CEt 424Wa'?d,2. . • .0 o. e CODE:Pren°d.`FKMAMOUNTDUE iii,
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
PAYMEW.YnYOR cnsRleR:�..i uicsaNl:... i,: . .COMMENTS' 'AMOUNTPAIU"�°—"�A9i-" ���
Check Benedettis Meat and Deli 93.60
. 1962 •
TOTAL PAID: 93.60
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Mechanical Permit Application DEPARTMENT USE ONLY
5li NGFIEls '
1 - Permit no.: �/l X13 'OZH3S
w
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225 Fifth Street•Springfield,OR 97477 • P11040726-3753 • FAX(541)726-3689 .. aypaEr024 Date: - lit/LIB
This permit is issued tinder 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
Li Residential I El Government 4 Commercial Residential Qty. Cost Total
ea. cost
JOB SITE INFORMATION AND LOCATION First Appliance $80.00 _ $
Job site address: SY)wQb4- C.CJkS.'/v al..-Vw? Furnace/burner including ducts and vents
Up to ] k BTU/hr. $18.50 $
City: ( l t2l J- State: �� ZIP: 10o k 'I
BTU,%hr. $22.00 $
Reference: Taxlot.:
Heaters/stoves/vents
DESCRIPTION OF WORK Unit heater $18.50 $
(0e5 //g� /‘:',-- Are7G Wood/pellet/gas stove/flue $42.00 $
/ , Repair/alter/add to heating appliance/
refrigeration unit or cooling system/ $80.00 $
PROPERTY OWNER /� absorption system
I
Name: e e--�'F244 r t P 1. c VA Gp 4N ` Evaporated cooler $14.50 $
B3 I 5 6 C e J_ ""Q;-1-4- Vent fan with one duct/appliance vent $10.00 $
Address: 2 0 16 3
Hood with exhaust and duct $14.50 $ i
City: State: ZIP:
Floor furnace including vent $80.00 $
Phone: - Fax: - - Gas piping
E-mail One to four outlets i $7.50 $
This installation is being made on property owned by me or a Additional outlets(each) $430 S
member of malp
it 'date family, and is exempt from licensing Air-handling units,including ducts
requiremen 701.010. - Up to 10000 CFM $12.00 $
Signature.. Over 10,000 CFM $22.00 $
t' ACTOR INSTALLATION Compressor/absorption system/heat pump
✓ Up to 3 hp/100kBTU $18.50 $
Business name:¶i '1-k- wt6,6 K Ll lm ih j i�i� Up to 15 hp/500k BTU $32.00 $
Address: �.V O� 1D6
J Up to 30 hp/1.000 BTU I $47.50 $
City: SWirt�`,J�ititi State:CAC ZIP:91 4T1 Up to 50 hp/1,750 BTU $62.50 $ ,
Phone: - - Fax: - - Over 50 hp/I.750 BTU $104.50 I $
E-mail: Incinerators !,.
v
l��' Domestic incinerator - ] $22.50 $
I
CCB license no.: 1/1 . 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
cost
Reinspection $80.00 $
Specially requested inspections(per hr.) 580.00 $
Regulated equipment(unclessed) $14.50 $
Each additional inspection:(t) $80.00 $
APPLICANT 'USE
(A)Enter subtotal of above fees(or enter set
minimum fee of $80.00) $
(B)Investigative tee(equal to[A]) $
(C)Enter 12%surcharge.(.12 x[A+B]) $
(0)Seismic fee, 1%(.01 x[A]) $
(E)Technology Fee(5%of[A]) $
440-2545-i(411/2013/C0l1) TOTAL fees and surcharges(A through E): $ q 3 6+