HomeMy WebLinkAboutPermit Mechanical 2013-12-30 •
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SPRINGFIELD 225 Fifth St
CITY OF SPRINGFIELD Springfield,OR 97477
' r eGO N Phone: 541-726-3753
Building / Residential Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2013-02757
www.springfield-or.gov permitcenterQspnngfield-or.gov
PROJECT STATUS: Issued ISSUED: 12/30/2013 EXPIRES: 06/28/2014
STATUS DATE: 12/30/2013 APPLIED: 12/30/2013
SITE ADDRESS: 225 E ST,Springfield,OR 97477 SCOPE: Mechanical Only
ASSESOR'S PARCEL NO: 1703352304200 TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: Install gas water heater
OWNER: LABRECQUE CHRISTER R Phone Number:
ADDRESS: 225 E ST •
SPRINGFIELD OR 97477
CONTRACTOR INFORMATION
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
Mechanical Contractor SHAD CHASAN SURRETT GCB 158295 01/15/2014 541-741-3553
INSPECTIONS REQUIRED II
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Inspections
2250 Gas Piping
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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 lo ted at the front of the property, and the approved set of plans will remain on the site at all times during
construction
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Owner or Contractor Signature Date
ATTENTION: Oregon law requires you to
n foilow rules adopted by the Oregon Utility
OTIVE. Notification Center. Those rules are set forth
in OA i 952-001-0010 through OAR 952-001-
H1S PERMIT SHALL EXPIRE IF THE WORK 0090. You may o fain co;a s of the ru!as by
.r.TIORIZED UNDER THIS PERMIT IS NOT
ca: i, g the cep?er. fKoie . ta;ephne
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•PINGED OR IS ABANDONED FOR number for the Oregon Utility hoti�ibatjon
150 DAY PERIOD. Center is 1-b00-%2-2344).
Springfield Building Permit 12/30/201 1:58:38PM Page 1 of 1
SPRINGFIELD CITY OF SPRINGFIELD
225 Fifth St
TRANSACTION RECEIPT Springfield,OR 97477
541-726-3753
OREGON
A 811-SPR2013-02757
www.springfeldor.gov 225 E ST permitcenter @spdngfield-or.gov
RECEIPT NO: 2013002756 RECORD NO:811-SPR2013-02757 DATE: 12/30/2013
DESCRIPTION 3j �SPFI _a...= ":'a -' ACCOUNT CODE/TRANS CODE.4. ,..-. /AMOUNThDUE 4
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#T F E MPAYOR cnst+lE raiii Ser COMMENTS . llIOUNT PAIDANI
Cash SHAD CHASAN SURRETT 93.60
TOTAL PAID: 93.60
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Mechanical Permit Application DEPARTMENT USE ONLY
$PRIIgGflELO
t µ I err [3—oZ
AT ,LOF SPRINGEIEWOREGON`= ‘-4.2- Permit no.: o
'. »a as_:a-'h e 4 x-.- -ant,.-�sa4-s.,.,s.•¢�xa.. ;-Mfr--r.�c.*,icssm}.�. ,{ tai -7 / /
j225 Fifth Street ♦ Springfield,OR 97477 • P18541)726-3733 • FAx(541)726 3689 { " OaeGON Dale: J Z/
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
14 Residential El Government 1:Commercial Residential Qty cost Total
JOB SITE INFORMATION AND LOCATION First Appliance $80.00 $
Job site address:2g S F 7 Furnace/burner including ducts and vents
Up to I00k BTU/hr. $18.50 $
City:S�,oN,3(Nflk State:p(Z Zll : Over 100k BTU/hr. $22.00 5
Reference: Taxlot.:
Heaters/stoves/rents
DESCRIPTION OF WORK Unit heater $18.50 $
U_J //r?z.1<{ s,.IS.St. Wood/pellet/gas stove/flue $42.00 $
Repair/alter/add to heating appliance/
refrigeration unit or cooling system/ $80.00 $
PROPERTY OWNER absorption system
Nameino Lc lj_ 6ec'Q J� Evaporated cooler $14.50 $
Address. E. 7 Vent fan with one duct/appliance vent $10.00 $
�� z �� �,�(('�� I-Iuud with exhaust and duct $14.50 S
City:lj a� State: CN�� ZIP: Floor furnace including vent $80.00 S
Phone:0 -/C/L/) Fax: - - Gas piping
E-mail: One to four outlets $7.50 $
This installation is being made on property owned by me or a Additional outlets(each) 54.50 5
member of my immediate family, and is exempt from licensing Air-handling units, including duets
requirements under ORS 701.010. Up to 10.000 CFM $12.00 $
Signature: Over 10,000 GEM $22.00 $
CONTRACTOR INSTALLATION Compressor/absorption system/heat pump
Up to 3 hp/100k BTU $18.50 $
Business name: S�ccS \°J^ Up to 15 hp/500k BTU $32.00 $
Address: VIQ 00->r_ Y/ Up to 30 hp/1,000 B'I'1J $47.50 $
City: `rr .Thge-td State: (Kt ZIP:974/l`1 Up to 50 hp/1,750 B'I'tl $62.50 $
Phonelf// -- ?6.5 41 Fax: - - Over 50lip/1.75013fU $104.50 $
E-mail: Incinerators
,r L�Q� Domestic incinerator 522.50 $
CCB license no.: ! Commercial
_Print name: 5._ � e Enter total valuation of mechanical system
Signature:
C and installation costs$
Enter fee bused on valuation of mechanical system,eta $
Miscellaneous fees Items Cost Toad
ea. cost
Iteinspection $80.00 $
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Specially requested inspections(per hr.) .00 $ -
$80 _
Regulated equipment(unclassed) 514.50 $
Each additional inspection: (11 .$80.00 S
APPLICANT USE
(A)Enter subtotal of above fees(or enter set
minimum fee of $80.00) $
(13)Investigative fee(equal to[Al) . $
(C)Enter 12%surcharge(.12 x[A+Bp $
(0)Seismic fee. I%(.01 x [Al) S
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(E)Technology Fee(5%of[A]) $
440-2545-1 N/1/2013/COxp TOTAL fees and surcharges(A through E): $73 G '