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HomeMy WebLinkAboutPermit Mechanical 2013-12-13 SPRINGFIELD 225 Fifth St lir-"- CITY OF SPRINGFIELD Springheld,OR 97477 `et, Phone: 541-726-3753 OREGON Building / Residential Permit Inspection Phone: 541-726-3769 Fax: 541-726-3676 PERMIT NO: 811-SPR2013-02673 www.springfield-orgov permitcenter©springfield-or.gov PROJECT STATUS: Issued ISSUED: 12/13/2013 EXPIRES: 06/11/2014 STATUS DATE: 12/13/2013 APPLIED: 12/13/2013 SITE ADDRESS: 624 64TH ST,Springfield, OR 97478 SCOPE: Pellet Stove/Insert ASSESOR'S PARCEL NO: 1702341300515 TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Pellet stove • OWNER: HOSKINS MARK W&KAREN K Phone Number: ADDRESS: 624 N 64TH 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 property, and the approved set of plans will remain on the site at all times during construction. _-P/CiAIR C4 2. nk /2—f3-i3 Owner or Contractor Signature Date ATTENTION. Oregon law requires you to - follow rules adopted by the Oregon Utility S PERMIT SHALL EXPIRE IF THE WORK in OAR 952 00 Center. Those rules are set forth ; T HORIZED UNDER THIS PERMIT 1S NOT • in OAR You may Copies of the rules by : J MENCED OR IS ABANDONED FOR 0090. You may obtain copies of the rules by calling the center. (Nnte:il ty telephation �Y 180 DAY PERIOD. number for the Oreg Center is i800-3322344). Springfield Building Permit 12/13/201 1:29:48PM Page 1 of 1 SPRINGFIELD CITY OF SPRINGFIELD al< 225 Fifth St <e l, TRANSACTION RECEIPT Springfield,OR 97477 -"'"' OREGON 541-726-3753 811-SPR2013-02673 www.springfield-or.gov 624 64TH ST permitcenter @springfield-or.gov RECEIPT NO: 2013002665 RECORD NO: 811-SPR2013-02673 DATE: 12/13/2013 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 „n PAYMENT TYPE PAYOR,CASHIER:CCARPENTER COMMENTS_ ,_,, ^., ,_ _ :AMOUNT PAID •. a Chck e _ HOSKINS MARK W&KAREN K 93.60µ 2051 TOTAL PAID: 93.60 • • Mechanical Permit Application DEPARTMENT USE ONLY . - SRINGFIELD CI W Q SP GFIl Q GOW Permit no.: Si 3— 22,73 . , 225 tlh Street • Springfield,OR 97477 • P161 )726-3753 • fAX(il 1)726-3689 ^tOREGON Date: l2 f3 /( 3 This permit is issued under OAR 918-440-0050. Permits expire if work is not started within 180 clays of issuance or if work is suspended for 180 days. CATEGORY OF CONSTRUCTION FEE SCHEDULE Residential CD Government ❑Commercial Residential Qty,. Cost Total ea. cost JOB SITE INFORMATION AND LOCATION First First Appliance / $80.00 $ P.) LOA Job site address: y t0 LI +(e S�Qe : C Furnace/burner including ducts and vents City: 5041 ..p o R$, A. State: O YL ( ZIP:C 79-is Up to 100k If[U/hr. $18.50 Over IOOk BTU/hr. $22.00 $ Reference: Taxlot.: Heaters/stoves/vents DESCRIPTION OF WORK 1 Unit he ter $18.50 Pa LL Q % .$*O Li 2 I N7 ' c IA Wood/pellet/gas stove/flue - I $42.00 S Repair/alter/add to heating appliance/ reli igeration unit or cooling system/ $80.00 S PROPERTY OWNER absorption systems Name: VIA A21( 14 uS ICI S Evaporated cooler $14.50 5 Vent fan with one duct/appliance vent $10.00 S Address: S A Z I food with exhaust and duet $14.50 S City: State: ZIP: Floor furnace including vent $80.00 S Phone:5411-7n-9(51 Fax: - - Gas piping E-mail: One to our outlets $7.50 $ This installation is being made on property owned by me or a Additional outlets(each) $4.50 5 member of my immediate family, and is exempt from licensing Air-handling units, including ducts requirements under ORS 701.010. �7 Up to 10.000 CM $12.00 S Signature: 749�,w X ¢X4ws. Over 10.00(1 CFM $22.00 $ CONTRACTOR INSTALLATION Compressor/absorption system/heat punj ____ n ? Up to 3 lip/IOOk BTU $18.50 $ Husines5 name: 1.114 `ei. .. ---........------ ----_.--$3 ------ -- Up to 15 hp/5001: KW $32.00 $ - Address tip to 311 hp/1,01111 1311i $47.50 $ City: State: ZIP: Up in 50 hp 71,750 um $62.50 S Phone: - - - Fax: - - Over 50 hp/1.750 13'11 $104.50 $ E-mail: Incinerators _ Domestic incinerator $22.50 I $ CCII license no.: Commercial Print name: Enter total valuation of mechanical system and installation costs$ Signature: Enter lee based on valuation of mechanical System.etc. $ Miscellaneous fees Items Cost Total ea. cost Reinspection $80.00 $ Specially requested inspections(per hr.) $80.00 S Regulated equipment(unclassed) $14.50 $ Each additional inspection;(I) $80.00 S APPLICANT USE (A)Enter subtotal of above fees(or enter set 00 minimum fee of $80.00) $X (B)Investigative fee(equal to[A]) $ e (C)Enter 12%surcharge(.12 x[A+BI) $ 9 a- (D)Seismic fee. I%(.01 x IA]) $ (E)Technology Fcc(5%of]A]) $ ( i 440-2545-1(4/1/2013/COM) TOTAL fees and surcharges(A through E): $ ej 3°p- 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 will inform my general contractor that all subcontractors who work on the structure must be licensed with the Construction Contractors Board. or NI 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. vl44ck u3. t-cskfw4 Print Name of Permit Applicant —744e !� - / 3 (3 Signature of Permit Applicant Date • Permit#: 5( / 26175 of • Address: 4.2—t( 6,4g I fT _—~� aN/ 50nA) /Ij2 r7747 r Issued by: 0t_Date: %Z//' / (7 859 This Copy for Permit Offices