HomeMy WebLinkAboutPermit Miscellaneous 2013-12-5 •
SPRINGFIELD • 225 Fifth St
CITY OF SPRINGFIELD Springfield,OR 97477
( &I {�_ Phone: 541-726-3753
rte - OREGON • Building / Residential Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2013-02623
www.springrielthor.gov permitcenter@springlield-or.gov
PROJECT STATUS: Issued ISSUED: 12/05/2013 EXPIRES: 06/03/2014
STATUS DATE: 12/05/2013 APPLIED: 12/05/2013
SITE ADDRESS: 1270 33RD ST,Springfield, OR 97478 SCOPE: Mechanical Only
•
ASSESOR'S PARCEL NO: 1702303406000 TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: Gas branch for range
OWNER: BRUHY SCOTT Phone Number:
ADDRESS: 1270 33RD ST
SPRINGFIELD OR 97478
CONTRACTOR INFORMATION
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
Mechanical Contractor C 8 R PLUMBING LLC GCB 167015 07/01/2014 541-736-9582
INSPECTIONS REQUIRED
Inspections
2255 Gas Pressure Test
2995 Final Gas Final Gas: When all gas 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 C tractor Signature Date
ATTENTION: Oregon law requires you to
follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth r QTI CE:
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 UTHORIZED UNDER THIS PERMIT IS NOT
calling the center. (Note: the telephone COMMENCED OR IS ABANDONED FOR
number for the Oregon Utility Notification
Center is 1-800-332-2344). ANY 180 DAY PERIOD.
Springfield Building Permit 12/5/2013 8:40:34AM Page 1 of 1
SPRINGFIELD CITY OF SPRINGFIELD
=4 d ..:ate 225 Fifth St
"-Set E�oN TRANSACTION RECEIPT Springfield,OR 97477
541-726-3753
811-SPR2013-02623
www.springfield-or.gov 1270 33RD ST permitcenter @springtield-or.gov
RECEIPT NO: 2013002614 RECORD NO:811-SPR2013-02623 DATE: 12/05/2013
[DESCRIPTION ACCOUNT CODE/TRANS CODE ` AMOUN1IDULJ
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
- ' -COMMENTS' . - -AMOUNT PAID '
PAYMENT TYPE PAYOR CASHIER:ccARPENrER COMMENTS - .. _ 'I
Credit Card C& R PLUMBING LLC 93.60
886089
TOTAL PAID: 93.60
•
Mechanical Permit Application DEPARTMENT USE ONLY
acs CITY OO F SERINGFIEEDTOREGON Permit no.: S/7 '26'23
-:( li /
225 Filth Street • Springfield,OR 97477 • P11(541)72C 3753 • FAX(54l)726 3689 [ `OREGON Date: /Z/5/2 JC
/2 5
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 —1 ❑Commercial Residential Qty. Cost Total
ea. cost
ta
JOB SITE INFORMATION AND LOCATION First Appliance / $80.00 $$Q
Job site address: ( Z7 0 3 3 rd 5 1` Furnace/burner inet ud i ng ducts and vents
City: car j f State: 01g— LIP: R7 y7 1 Up to IDOL B'i tJ/hr. $18.50 $
T Over I OOk 1)TU/hr. $22.00 S
Reference: /702- 76 3 y Taxlol.:06GrCJC-S
Heaters/stoves/vents
DESCRIPTION OF WORK Unit heater $18.50 S
ry r. a / /aS /r;1.e 4, ✓ t" Wood/pellet/gas stove/flue $42.00 $
/ Repair/alter/add to heating appliance/
reti igeni Mil unit or cooling system/ $80.00 $
PROPERTY OWNER absorption system
Name: 13261/7'-7 Evaporated cooler $14.50 S
Address: /2-70
33 r) S`f - Vent fan with one duct/appliance vent $10.00 S
Hood with exhaust and duct $14.50 S
City: Sc.C.)a State: 0-2 ZIP: a 7 H 7 8-
Floor furnace including vent $80.00 S
Phone: - - Fax: - - Gas piping
E-mail: One to four outlets / $7.50 $ 745
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 under ORS 701.010. Up to 10.000 CFM $12.00 S
Signature: Ove(10.000 CFM $22.00 $
CONTRACTOR INSTALLATION Compressor/absorption system/heat pump
n --- l.lp to3 hp/100k 1310 $18.50 $
,
Business name: e 4 A..-pnb,L1 ---- Up to 15 hp/5001;Bl'U $32.00 $
Address: 37b o Ka Rnryen Att • _ .
Up to 3(1 hp/L01111 B11, $47.50 $
City: S (J State: pR_ ZIP: °li7 L(7r Up to 50 hp/1,750 BTII $62.50 $
Phone:<q/-Zot 76(I Fax: - - Over 50 hp/1,750 BTU $104.50 $
E-mail: Lp p(� 6 ( VA�teo. Ley, Incinerators G Domestic incinerator $22.50 $
CCB license no.: /6'7 p/ r --
�1 Commercial •
Print name: Oct rF 4rrt-e Enter total valuation of mechanical system
///����111 ✓ p and installation costs$
Signature: /A— -6 linter fee based on valuation or mechnnicalsystem.etc. $
_ �/7 Miscellaneous fees Items Cost Total
ea. cost
Reinspection $80.00 $
Specially requested inspections(per hr.) $80.00 $
Regu bled equipment(unclassed) $14.50 $
Each additional inspection:(I) $80.00 S
APPLICANT USE •
(A)Enter subtotal of above fees(or enter set �°
minimum fee of $8000) >CJ . 0(3—.
(13)Investigative fee(equal to[A]) $
(C)Enter 12%surcharge(.12 x[A+Bp $ /..r—Sp 9l
(D)Seismic fee. I%(.01 x[A]) $ .. $
(E)Technology Fee(5%of[AB $ t ��-
410-2545-1(4!1!2013/COM) TOTAL fees and surcharges(A through E)__-__$ 1 �i3�...—