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HomeMy WebLinkAboutPermit Mechanical 2013-12-31 • 2 . SPRINGFIELD 225 Fifth St CITY OF SPRINGFIELD Springfield,OR 97477 ' �', • i - Phone: 541-726-3753 OREGON Building / Residential Permit Inspection Phone: 541-726-3769 Fax: 541-726-3676 . PERMIT NO: 811-SPR2013-02771 • www.springfield-or.gov permitcenter@springfield-or.gov PROJECT STATUS: Issued ISSUED: 12/31/2013 EXPIRES: 06/29/2014 STATUS DATE: 12/31/2013 APPLIED: 12/31/2013 SITE ADDRESS: 921 6TH ST,Springfield,OR 97477 SCOPE: Mechanical Only ASSESOR'S PARCEL NO: 1703351204800 TYPE OF STRUCTURE: Residential PROJECT DESCRIPTION: Replace Gas Furnace OWNER: BUCKMASTER KIMBERLY Phone Number: ADDRESS: 921 6TH ST SPRINGFIELD OR 97477 • CONTRACTOR INFORMATION Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone Mechanical Contractor DEAN M SHULTZ CCB 183169 08/09/2014 208-573-4714 INSPECTIONS REQUIRED 1 Inspections 2170 Fuel Burning Appliance 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. /// 'v 2/-6) 113 . Own or Contractor Sit ature Date • • • NOTICE: ATTENTION: Oregon law requires you to THIS PERMIT SHALL EXPIRE IF THE WORK follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth AUTHORIZED UNDER THIS PERMIT IS NOT in OAR 952-001-0010 through OAR 952-001- COMMENCED OR IS ABANDONED FOR 0090. You may obtain copies of the rules by ANY 180 DAY PERIOD. - calling the center. (Note: the telephone • number for the Oregon Utility Notification Center is 1-800-332-2344). • Springfield Building Permit 12/31/201 2:15:25PM Page 1 of 1 • SPRINGFIELD - CITY OF SPRINGFIELD -r}+ 225 Filth St TRANSACTION RECEIPT Springfield,OR 97477 OREGON 541-7263753 811-SPR2013-02771 wwwspringfie1d-or.goy 921 6TH ST permitcenter©springfield-or.gov RECEIPT NO: 2013002767 RECORD NO:811SPR2013-02771 DATE: 12/31/2013 D -1' „t,;t:.1Tr ft,"°.,.- =, ___ ACCOUNIICODE/TRANSCODE '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 �._._r PAYMENT TYPE i'3, " PAYOR .-�.CASHIER:���LARSON„mss-” '�- � '� ' + `AMOUNT.PAID" � �h - .,...�_—:COMMENTS ��;..;�"�, _ .�.e...c,.. ��. y_a���;rw�E:;hei+ Cash DEAN M SHULTZ 93.60 TOTAL PAID: 93.60 • Mechanical Permit Application DEPARTMENT USE ONLY • Iv- 'i,'*,, "_-§ a" .a, -t; '.-.„ sj s x SPRINGFIELD - ATY OF SP,RINGFIELEr) REGONNNNN Permit no.: ___ `- .9, -c aka r .n -ec k: +.^3c- ell { 225 Fifth Street •Springfield,OR 97477 • PH(541)726-3753 • FAX(541)726 3689 s OREGON Date: 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. J CATEGORY OF CONSTRUCTION FEE SCHEDULE /Residential ❑Government ❑Commercial Residential Qty. Cost Total ea. Cost JOB SITE INFORMATION AND LOCATION First Appliance - $80.00 $ Job site address: Furnace/burner including ducts and vents City: Sq.,�uyc-y1 Stater(` ZIP: 7 11 Up to I 00 BTU/hr. $18.50 $ —*n° 7 � Over 100k BIUIhr. $22.00 $ Reference: Taxlot.: Heaters/stoves/vents DESCRIPTION OF WORK Unit heater $18.50 .$ _ _r V , ' AP._ Wood/pellet/gas stove/flue $42.00 $ _ Repair/alter/add to healing appliance/ refrigeration unit or cooling system/ $80.00 $ PROPERTY OWNER absorption system Name: 'A I4 ' ,titiA( .5� Evaporated cooler $14.50 $ VV'' Vent fan with one duct/appliance vent $10.00 $ Address: el-Li Kt, oh 61, p Hood with exhaust and duct $14.50 $ City: .l t ,�A Stale:� _,_1, ZIP:q'7 17_ Floor furnace including vent $80.00 $ Phone: `1 011ie Fax: - - Gas piping • E-mail: One to lour 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 duets requirements under ORS 701.010. Up to 10.000 CFM $12.00 $ Signature: Over 10.000 CFM $22.00 $ CONTRACTOR INSTALLATION Compressor/absorption system/heat pump �� LH, . Up to 15hp/500 BTU $18.50 $ Business name: It A, Up to I$hp/500k RTU $32.00 $ Address:Too P)O\ Up to 30 hp/1.000 Bill $47.50 S City:C 51)05 \ State:Or ZIP: 9191 j Up to 50 hp/1,750 BTU $62.50 $ Phone:5y1 9451862'L Fax: - - Over 50 hp/l.750 BTU $104.50 $ E-mail: Incinerators _ . . -- ;2' .� Donlesl is incinerator $22.50 $ CCB license no.: J Commercial Print name: is 1�� ` - Enter total valuation of mechanical system V,'I and installation costs$ J^ � Enter lie based on valuation of mechanical syslem,etc. Si Miscellaneous fees Items Cost Total ea. cost Rcinspection $80.00 $ Specially requested inspections(per hr.) $80.00 $ Regulated equipment(uncl assed) $14.50 $ Each additional inspection:(I) $80.00 S APPLICANT USE (Al Enter S010018l of above fees(or enter set minimum fee of $80.00) • $ (B)Investigative fee(equal to[A]) $ (C)Enter 12%surcharge(.12 N[A+B]) $ (D)Seismic fee. I%(.01 x [Al) $ (E)Technology Fee(5%of[AJ) $ 440-2545-1(4/1/2013/COM) TOTAL fees and surcharges(A through E): $