HomeMy WebLinkAboutPermit Mechanical 2014-1-13 yA I
SPRINGFIELD- 225 Fifth St
- '< CITY OF SPRINGFIELD Springfield.OR 97477
Phone: 541-726-3753
OREGON Building I Residential Permit Inspection Phone: 541-726-3769
• Fax: 541-726-3676
PERMIT NO: 811-SPR2014-00076
www.springfield-or.gov perm itcenter @springtield-or.goy
PROJECT STATUS: Issued ISSUED: 01/13/2014 EXPIRES: 07/12/2014
STATUS DATE: 01/13/2014 APPLIED: 01/13/2014
SITE ADDRESS: 2560 35TH ST,Springfield,OR 97477 SCOPE: Wood Stove/Insert
ASSESOR'S PARCEL NO: 1702194200300 TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: Wood stove replacement
OWNER: JARVIS SHANNON 0 Phone Number:
ADDRESS: 2560 35TH ST
SPRINGFIELD OR 97477
OWNER: WILSON MICHAEL D Phone Number:
ADDRESS: 2560 35TH ST
SPRINGFIELD OR 97477
CONTRACTOR INFORMATION
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
Mechanical Contractor OWNER CCB 000000 08/01/2025
LINSPECTIONS 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.
•
Owner or Contractor Signature Date
ATTENTION: Oregon law requires Util t
follow rules adopted by the Oregon
NOTICE: •
Notification Center. Those rules are set forth
in OAR 952-001-0010 through OAR 952-001- THIS PERMIT SHALL EXPIRE IF THE WORK
0090. You may obtain copies of the rules by AUTHORIZED UNDER THIS PERMIT IS NOT•calling the center. (Note: the telephone
number for theiOregon-332Utility Notiflcation COMMENCED DAY PERIOD. ANDONED FO
ANY•
•Springfield Building Permit 1/13/2014 9:59:47AM Page 1 of 1
SPRINGFIELD CITY OF SPRINGFIELD
225 Fifth St
f� ��; TRANSACTION RECEIPT Springfield.OR97477
`
OREGON 541-726-3753
811-S P R2014-00076
www.springfield-or.gov 2560 35TH ST permitcenter @springfield-or.gov
RECEIPT NO: 2014000061 RECORD NO:811-SPR2014-00076 DATE:01/13/2014 •
/DESCRIPTION4_ _ ___ .,_ _ , _ _ °.:_ 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
(_1 PAYMENT TYPEPAYOR CASHIER:CCARPENTER COMMENTS . ' AMOUNT PAID
Cash WILSON MICHAEL D 93.60
TOTAL PAID: 93.60
•
DEPARTMENT USE ONLY .ex
Mechanical Permit Application
q.t .ty yoR ), � {yt+r:Z;s .�1' 1 n4�fi „°n SPHINGFIELO /y')
`�' + tt;: t ; W. `'L`Y 3 IM1§#*15�] Z Y.i' s: Y�y' Y coo 7 /
I " CITY OF SPRllvGFIELD t0REGON Permit no.: 5l /
225 Fifth Street• Springfield,OR 97477 • PH(541)726-3753 • FAX(541)726-3689 ", /P31/ 9 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. -
_ +t ' CATEGORVOF CONSTRUCTION, F*;, � IyF,EE,:s.P.11EPOIrEVM1:46::ealW
tesidential ❑Government ❑Commercial :Resiil`entlal kea`DiN- Qh ' east ;costl
° 'JOBnSITE INFORMATIoAtic:N_D,Y:igpIPArjorlt..ggin First Appliance / $80.00 $
Job site address: 2560 �,S' _57C Furnace/burner including ducts and vents
CitY:4 n ,elf State: 62,4). ZIP: 77977 Up to look BTU/hr. $18.50 $
L Over 100k BTU/hr. $22.00 $
Reference: / 7612. /c tit Z Taxlot(xj 3 ot7
2,e hvs ; .., _ Heaters/stoves/vents
,I, g( itifi�ESCRII ON; OF�WORK- ? p Unit heater $18.50 $
G✓OOo( S/ote /Ate nf,/4cc''-e51t Wood/pellet/gas stove/flue .$42.00 $ Cj
Repair/alter/add to heating appliance/
refrigeration unit or cooling system/ $80.00 $
;(2:08r' u t 10FLROPERTY OWNER,g;l tr ''WN• °z i absorption system
Name: 74 tk�' Evaporated cooler $14.50 $
Vent fan with one duct/appliance vent $10.00 $
Address:
Sqne GS 014.7.'e Hood with exhaust and duct $14.50 $
City: State: ZIP: Floor furnace including vent $80.00 $
Phone:`1(-75- 472 7i 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) $4.50 $
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 $
Signature - Li.j Over 10,000 CFM $22.00 $
*attri,,, ;CONTRACTOR INSTAL*LATION4 rt '; ,,"try Compressor/absorption system/heat pump
Business name:
Up to 3 hp/100k BTU $18.50 $
92,//t./ . -
Up to 15 hp/500k BTU $32.00 $
Address: Up to 30 hp/1,000 BTU $47.50 $
City: State: ZIP: Up to 50 hp/1,750 BTU $62.50 $
Phone: - - Fax: - - Over 50 hp/1,750 BTU $104.50 $
E-mail: Incinerators
Domestic incinerator $22.50 $
CCB license no.:
Commercials su,x t. 5^fig
Print name: Enter total valuation of mechanical system
and installation costs$
Signature: Enter fee based on valuation of mechanical system,etc. $
:7Cea st ,Tdtal :?
'MISCellareoUS+feesr t $ ' 1e ms - •;
Reinspection $80.00 $
Specially requested inspections(per hr.) $80.00 $
Regulated equipment(unclassed) $14.50. $
Each additional inspection:(1) $80.00 $
-' -, 3 ~tVAPPLICANTu;USE t eltiN ,Sc,;,"n+r <=s°'.
(A)Enter subtotal of above fees(or enter set
minimum fee of $80.00) $
(B)Investigative fee(equal to[A]) $
(C)Enter 12%surcharge(.12 x[A+B]) $
(D) Seismic fee, 1%(.01 x [A]) $
(E)Technology Fee(5%of[A]) $ (%
•
440-2545-1(4/1/2013/COM) . TOTAL fees and surcharges(A through E): $/3