HomeMy WebLinkAboutPermit Mechanical 2013-12-19 SPRINGFIELD 225 Fifth St •
' CITY OF SPRINGFIELD Springfield,OR 97477
I coot Phone: 541-726-3753
SPA \OREGON
Building / Residential Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2013-02706
www.springfield-or.gov perrnitcenter @spring field-ar.gov
PROJECT STATUS: Issued ISSUED: 12/19/2013 EXPIRES: 06/17/2014
STATUS DATE: 12/19/2013 APPLIED: 12/19/2013
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SITE ADDRESS: 844 RIVER KNOLL WAY,Springfield,OR 97477 SCOPE: Mechanical Only
ASSESOR'S PARCEL NO: 1703234311300 TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: Replace gas water heater
OWNER: HOWARD WAYNE D&KATHERINE F Phone Number:
ADDRESS: 844 RIVER KNOLL WAY
SPRINGFIELD OR 97477
CONTRACTOR INFORMATION
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
Mechanical Contractor OWNER CCB 000000 08/01/2025
L INSPECTIONS REQUIRED
Inspections
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.�'p
l,�L � °j4 / 2 !q'—!7
Owner or Contractor Signature Date
utres you to
P on ly t req Utiltt V�ORK
ATTENTION Or g d by the Oregon Y •
4OIIOW rules adopt h Oar 952-001- ��Q[AGE: ��EXPIRE IF 1NT 1S N0�
Notifipatton Center. Those rules are rules th TI{IS PERMIT SHP ER iv*A��NED FOR
In OAR 952"--,:1 0010 through O
You maObtain copies of the r by ���THpR1ZED
0090. Note'. the telephone UO IS A
calling the center. (on Utility Notification COALMEN D PY PERIOD
number for the Oreg ANA 180
Center Is 1-800-332-2344).
Springfield Building Permit 12/19/201 10:26:50AM Page 1 of 1
SPRINGFIELD CITY OF SPRINGFIELD
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1 oi�. 225 Fifth St
`` ``'OR"6GOH TRANSACTION RECEIPT Springfield,OR97477
541-726-3753
811-SPR2013-02706
www.springfield-or.gov 844 RIVER KNOLL WAY permitcenter @springfield-ocgov
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RECEIPT NO: 2013002707 RECORD NO:811-SPR2013-02706 DATE: 12/19/2013
IDESCRIPTION - _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
LPAYMENT TYPE PAYOR ' CASHIER:CCARPENTER • _COMMENTS _ - __ __AMOUNT PAID • : i
Cash HOWARD WAYNE D&KATHERINE F _ 93.60^
TOTAL PAID: 93.60
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Mechanical Permit Application DEPARTMENT USE ONLY
1.5%,,,,?:_-- ,ae?: 1 •F ,.A*:;; '2:1-'1 s :.:. 2, r SP1IiJGPIELO �OL70 6
CITE OF, SPyR GFE ORE ONE' „, ~_ Permit no.:5/�
225 Fifth Street • Springfield OR 97477• P11(541)726-3753 • FAX(54I)726 3689 � "
OREGON D{1iq: l '
This permit is issued under OAR 918-440-0050. Permits expire if work is not started within(18_0 clays of issuance or if work is
suspended for 180 days.
CATEGORY OF CONSTRUCTION FEE SCHEDULE
Itesiticntial ❑Government ❑Commercial Residential Qty, Cost Total
ea. cost
JOB SITE INFORMATION AND LOCATION First Appliance ( $80.00 $
Job site address:67 41 gl r52 k_n o�f Furnace/burner including ducts and vents
Up to 10(1k BTU/hr. $18.50 $
City: SIOI ��
'D StaLlf: / 77
I, Over look B-run, . $22.00 $
Reference:'7b3 13 'I 3 Taxlot.:l/30 O
Heaters/stoves/vents
������
DESCRIPTION OF WORK Unit heater $18.50 $
qq
� eitie4ce' t. 4-r&2 //mire✓_ Wood/pellet/gas stove/flue $42.00 S
Repair/alter/add to heating appliance/
' -- refrigeration unit or cooling system/ $80.00 $
PROPE TY•' OWNER absorption system
Name: WIWI-Q., bow Evaporated cooler $14.50 S
Address:
$ti- vet Litt.- jr{0 LL w t`( Vent fan with one duct/appliance vent $10.00 S
SICCLK6-f Hood with ce including duel $14.50 S
City: ��i.L�/ State: ��. ZIP: 97 Floor furnace including vent $80.00 $
Phone5tfc 7� /7116 Fax: - �p- Gas piping
E-mail: W/ryr-f4j/su 3tp SO Q l_ °L GU^'x- One to four outlets $7.50 S
This installation is being made on property owned by me or a Additional outlets(each) $4.50 S
member of my t ,mediate family, and is exci from licensing Air-handling units, including duets
requirement a dl RS,791. I Q'. GL �// Upto 10.000 CF61• $12.00-
Signature: r'7"/�(/'7/�(f/�1y9'�,'f'/ over 10.000 UM $22.00 S
CONTRACTOR INSTALLATION Compressor/absorption system/heat pump
���� Up to 3 lip/100k BTU $18.50
Business name: --- ---
Up to 15 hp/500k BTU $32.00 $
Address: Up to 30 hp/1.000 BTU $47.50 S
City: State: LIP: Up to 50 hp/I.750 BTI I $62.50 $
Phone: - - Fax: - - Over 50 hp/1;750 11Th $104.50 $
E-mail: Incinerators -
Domestie incinerator 522.50 $
CCB license no.: Commercial
Print (tame: _ Enter total valuation of mechanical system
and installation costs$
Signature: ._ _...._..-....
Enter fee based on valuation of mnehanical system,etc. $
Miscellaneous fees Items t-oil Total
ea. cost
Reinspectioit $80.00 $
Specially requested inspections(per hr.) $80.00 S
Regulated equipment(uuclassed) $14.50 $
• ' Each additional inspection:(I) $80.00 S
APPLICANT USE
(A)Enter subtotal of above fees(or enter set
minimum fee of $80_00) PrO
(B)Investigative fee(equal to[A]) $
(C)Goer 12"/surcharge(.12 x[A+BI) $
(B)Seismic fee. I%(01 x [Al) $
(E)Technology Fee(5%of[A]) --$ ------� •
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440.2545.1(1/1/2013/CONI) TOTAL fees and surcharges(A through Ej: $ .7 6 o