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Home My WebLink AboutPermit Mechanical 2013-12-12 SPRINGFIELD 225 Fifth St 14.46.44i CITY OF SPRINGFIELD Springfield,OR 97477 �+ ► Phone: 541-726-3753 ° Building / Residential Permit Inspection Phone: 541-726-3769 Fax: 541-726-3676 PERMIT NO: 811-SPR2013-02664 www.springfield-or.gov permitcenterlspringfield-or.gov PROJECT STATUS: Issued ISSUED: 12/12/2013 EXPIRES: 06/10/2014 STATUS DATE: 12/12/2013 APPLIED: 12/12/2013 SITE ADDRESS: 240 S 71ST ST,Springfield,OR 97478 SCOPE: Pellet Stove!Insert ASSESOR'S PARCEL NO: 1702353406501 TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: New pellet stove OWNER: NULL DEBORAH L Phone Number: ADDRESS: 240 S 71ST ST SPRINGFIELD OR 97478 CONTRACTOR INFORMATION Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone Mechanical Contractor OWNER CCB 000000 08/01/2025 INSPECTIONS REQUIRED i 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 property, and the approved set of plans will remain on the site at all times during construction. — Ma-Va-►3 Owner or Contractor Signature Date • :Mr • :S PEti,ii I SHALL EXPIRE IF THE WORK .THORIZED UNDER THIS PERMIT IS NOT .111ENCED OR IS ABANDONED FOR 180 DAY PERIOD. Springfield Building Permit 12/12/201 2:57:48PM Page 1 of 1 SPRINGFIELD CITY OF SPRINGFIELD TRANSACTION RECEIPT Springfield,0R97477 11110#REGON 541-726-3753 811-SPR2013-02664 www.springfield-or.gov 240 S 71ST ST permitcenter@springfield-or.gov RECEIPT NO: 2013002656 RECORD NO:811-SPR2013-02664 DATE: 12/12/2013 DESCRIPTION ACCOUNT CODE/TRANS CODE AMOUNT DUE 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 PAYMENT TYPE PAYOR CASHIER:CCARPENTER COMMENTS AMOUNT PAID Cash NULL DEBORAH L 93.60 TOTAL PAID: 93.60 Property Owner Statement Regarding Construction Responsibilities Oregon Law requires residential construction permit applicants who are not licensed with the Construction Contractors Board to sign the following statement before a building permit can be issued. (ORS 701.325 (2)) This statement is required for residential building, electrical, mechanical, and plumbing permits. Licensed architect and engineer applicants, exempt from licensing under ORS 701.010 (7), need not submit this statement. This statement will be filed with the permit. Please check the appropriate box: I own, reside in, or will reside in the completed structure and my general contractor is: Name CCB# Expiration Date I will inform my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. or \Y I will be performing work on property I own, a residence that I reside in, or a residence that I will reside in. If I hire subcontractors, I will hire only subcontractors licensed with the Construction Contractors Board. If I change my mind and hire a general contractor, I will select a contractor who is licensed with the CCB and will immediately give the name of the contractor to the office issuing this Building Permit. I have read and understand the Information Notice to Homeowners About Construction Responsibilities, and I hereby certify that the information on this homeowner statement is true and accurate. Print Name of Permit Applicant r � �- I `a�ta- l3 Signature of Permit Applicant Date Permit#: S 13 _ 2 o F Address: 2y0 C. 7/ S� _ �: ++►%3'�_ ACT Issued by: Date: /2--// /0 59 This Copy for Permit Offices Mechanical Permit Application DEPARTMENT USE ONLY 5PiUNGFtELA CITY OF SPRINGFIELD, OREGON Permit no.:5! 3-- 2606, Y r 225 Filth Street• Springfield.OR 97477 • PFI(5.11)726-3753 t• FAX(541)726.3(i89 OaEGON Date: /71/2/I 3 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 ID Government ❑Commercial Residential Qty, Cost Total ea. cost JOB SITE INFORMATION AND LOCATION First Appliance $80.00 S Job site address: 3413 ami-h, el 15► Furnace/burner including ducts and vents ' Up City.rt(se/(AA State:0e ZIP:C/?C{0 Over to 10()k B'1U/ltr. $22.00 $ `'t' Over 100k BTU/hr. $22.00 $ Reference: Taxlot.: - DESCRIPTION OF WORK Heaters/stoves/vents , Unit heater 518.50 $ it\ I 1 36-L- Wood/pellet/gas stove/flue I $42.00 S 1<2 Repair/alter/add to heating appliance/ -- refrigeration unit or cooling system/ 580.00 S PROPERTY OWNER absorption system Name:i (r\, L- J1,6j Evaporated cooler 514.50 S Vent fan with one duct/appliance vent 510.00 S Address: {). f Si Hood with exhaust and duct 514.50 S City: r Q(d I State:( ZIPR1lr7 Floor furnace including vent 1 580.00 S Phone:003g -(09-DC) Fax: - - Gas piping ___ E-mail: Cnk r-Old 5 44 a e a_ot...CorA. 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 requirement nder ORS 701 010. Up to 10.000 CFM $12.00 S Signature: k i.Lsz JLA.ty0,-1 _..1„_7". .,(..._ Over 10.000 CFM $22.00 S CONTRACTOR INSTALLATION Compressor/absorption system/heat pump Business name: it/fvt✓�- Up to 3 hp/lOOk BTU $18.50 $ Up to 15 hp/500k BTU $32.00 $ Address: Up to 30 hp/1.000 BTU S47.50 $ City: State: ZIP: Up to 50 hp/I,750 BTU $62.50 S Phone: - - Fax: - - Over 50 hp/1.750 BTU $104.60 $ E-mail: Incinerators ' Domestic incinerator I 522.50 l $ CCB license no.: Commercial Print name: Enter total valuation of mechanical system and installation costs$ Signature: Enter fee based on valuation of mechanical system,etc. S Miscellaneous fees Items Cost Total en. cost Reinspection $80.00 $ Specially requested inspections(per hr,) $80.00 $ Regulated equipment(unclassed) $14.50 $ Each additional inspectlon: (1) $80,00 $ APPLICANT USE (A)Enter subtotal of above fees(or enter set �� minimum fee of $MD) $ (]U F (B)Investigative tee(equal to[A]) $ (C)Enter 12%surcharge(.12 x[A+B]) $ q 6'5' (D)Seismic fee. 1%(.01 x [A]) $ (E)Technology Fee(5%of[A)) $ It 691-r- 440-2545.1(41/2013/COM) TOTAL fees and surcharges(A through E): $/56'..-?----