HomeMy WebLinkAboutPermit Mechanical 2013-12-24 Mechanical Permit Application DEPARTMENT USE ONLY I SPRINGFIE►O
Permit no.: ��� ��� 2 CIT%' OF SPRINGFIELD, OREGON /�f i
225 Fifth Street ♦ Springfield,OR 97477 PH(541)726-3753 • FAX(541)726 3689 OREGON i Dale. r % ` % /3
This permit is issued under OAR 918-440-0050. Permits expire if work is not started within I$0 days of issuance or if work is
suspended for 180 days.
l CATEGORY OF CONSTRUCTION FEE SCHEDULE
U Residential ❑Government (Commercial Residential Qty Cas ►
cost
r JOB SITE INFORMATION AND LOCATION First Appliance 580.00 S
/►,.� �1 Furnace/burner including ducts and vents
Job site address (p ; f kal-K ,7 • $18.50 S
Up to 100k BTU•hr.
City: c��w4�� State' j1 LI P:47+�l7g Over 100k BTU/hr. 522.00 S
Reference: Taxlot.: Heaters/stoves/vents
DESCRIPTION OF WORK _ Unit healer l $18.50 S
-ric ,, ' ! , C. `�, - r./ • Wood/pellet/gas stove/flue $42.00 $
� Repair/alter/add to heating appliance!
�J refrigeration unit or cooling system/ $80.00 S
PROPERTY OWNER absorption system
Name:
1l4OS e_ Evaporated cooler 514.50 S
1 Z 01-4-1 4-'L Vent fart with one duct/appliance vent - $10.00 S
Address: //� Hood%vith exhaust and duct $14.50 $
City: T GT{' f - State: �Z ZIP_ Floor furnace including gent $80.00 S
Phone:r� ? 90 oo-1S !J Fax:�j�// G s :_ b3hr Gas piping
E-mail 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 immediate family, and is exempt from licensing Air-handling units,including ducts
requirements under ORS 701.010. Up to 10,000 CFM $12.00 I $
Signature: _- Over 1 0,000 CFM $22.00 $
CONTRACTOR INSTALLATION , Compressor labsorptianlystemlheat pump
Up to 3 hp/IOOk BTU S18.50 $
Business name: 4(4,40- Up to 15 hp/500k BTU $32.00 S
Address: '4 ILO D •Aug,L — 1 - Up to 30 hp/1,000 BTU $47.60 $
City: o` �I/I e1�_ ZIP: ',of a Up to 50 hp/1,750 BTU ______ $62.50, $
Phone: 5
L Fax: `?4/- 1) Over 50 hp/1,750 BTU $104.50 _S
E-mail: 64t A-Ar<6.014 kir_-[' Incinerators
Domestic incinerator 1 $22.50 S
CCB license no.: 67ere ou to Commercial
t,it�
Print name: ( i\I Enter total valuation of mechanical sys m
\01't -' � - ` - .te '-3 a4A- and installation costs$ /0 S 7_
1g�i :� ...z-.
"" ' �' Enter fee based an valuation of mechanical system,etc. S
\t: t• t�i` S'* SU����y Cost Total
{allow to Qp10`b °u`� of ills hoCle Miscellaneous fees items
Nottt'tca�ot�G' tat capes a teleP r cost—
,t
t 6,
in,a�R ou may ob ` lNote:tr Noti t,catto Reinspection $80.00 $
pogo. the cents . on{}tdtt`1 ., \' Specially requested inspections(per hr.) $80.04 $
callln9 toC the 0(egp0 332-23 Regulated equipment(unclassed) $14.50 S
PumbelCenteC \S { Each additional inspection:(I) 580.00 5
APPLICANT(A)Enter subtotal of above a e05 /7 z ?3
minimum lee of tiS ,N(1 /
r.�8)In stig� n'fee(��y�il � i-0\A $ 7.r
(t ) smip i . I+x[AD 5 p
(E)Technolo /o of[A)) $ Q
440-2545-1(4ri/2013/COM) TOTAL fees and surcharges(A through E): $ ?O Z..' 3
Eg'd TEN) TPL TVS • 'DNI ST1UHSdUW SS:ET Flom-0E—D311
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-SPR2013-02729
www.spnngfieid-or.gov permitcenter@springfield-or gov
PROJECT STATUS: Issued ISSUED: 12/24/2013 EXPIRES: 06/22/2014
STATUS DATE: 12/24/2013 APPLIED: 12/24/2013
SITE ADDRESS: 6898 MAIN ST,Springfield, OR 97478 SCOPE: Heating System
ASSESOR'S PARCEL NO: 1702353205317 TYPE OF STRUCTURE: Commercial
PROJECT DESCRIPTION: Install package HP on roof/replacement
OWNER: GIBSON&GIBSON LLC Phone Number:
ADDRESS: 125 E 6TH AVE
JUNCTION CITY OR 97448
CONTRACTOR INFORMATION
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
Mechanical Contractor MARSHALLS INC COB 25790 12/23/2015 541-747-7445
INSPECTIONS REQUIRED II
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 1 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 Contra for Signature 13 Date 4 `
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Or wOR
A� E iesad l 1,13-c �: S>�A11- pIR� Ml� �I �D�
io11ow ru�E Ge�,,�f. D1yDER THANpD�yED
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Springfield Building Permit 12/241201 8:59:13AM Page 1 of 1-
SPRINGFIELD CITY OF SPRINGFIELD
.,..Laiiiiiiii
225 Fifth St
TRANSACTION RECEIPT Spnngfield,0R97477
�'' OREGON 541-726-3753
81 1-S P R2013-02729
www.spnngfield-orgov 6898 MAIN ST permdcenterCspnngfield-or gov
RECEIPT NO: 2013002730 RECORD NO: 811-SPR2013-02729 DATE: 12/24/2013
Mechanical Permit fee(based on value of work) 224-00000-425604 1006 172.93
State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 20.75
Technology fee(5%of permit total) 100-00000-425605 2099 8.65
TOTAL DUE: 202.33
_ 1 i.-,
Credit Card marshall dannen 202.33
09773d
TOTAL PAID: 202.33