HomeMy WebLinkAboutPermit Mechanical 2014-1-24 SPRINGFIELD 225 Fifth St
'' — CITY OF SPRINGFIELD Springfield,OR 97477
Phone: 541-726-3753
OREGON Building / Residential Permit Inspection Phone: 541-726-3769
Fax• 541-726-3676
PERMIT NO: 811-SPR2014-00150
www springfield-or gov permtcenteri spnngfield-or gov
PROJECT STATUS: Issued ISSUED: 01/24/2014 EXPIRES: 07/23/2014
STATUS DATE: 0112412014 APPLIED: 01/24/2014
SITE ADDRESS: 544 S 46TH ST,Springfield,OR 97478 SCOPE: Mechanical Only
ASSESOR'S PARCEL NO: 1702324307402 TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: Pellet Stove
OWNER: BLOOD LIVING TRUST Phone Number:
ADDRESS: 91613 MARCOLA RD
SPRINGFIELD OR 97478
CONTRACTOR INFORMATION
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
Mechanical Contractor DANIEL E TETZLER CCB 48631 11'08/2014 503-345-7909
INSPECTIONS REQUIRED
Inspections
2140 Pellet, Gas, Fireplace or Wood Wood Stove. After Installation
Stove
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.
Owner or Co ractor Signa re Date
NOTICE:
PERMIT SHALE EXPi E IF I ht
. IORIZED UNDER -I HiS PERMIT
1.:D.) ,'1' ENCED OR IS ABANDONED ft'
ANY 180 DAY PERIOD.
Springfield Building Priam 1/24/2014 2:13:54PM Page 1 of 1
SPRINGFIELD CITY OF SPRINGFIELD
Finn R
lit.:‘ 225 Fi
TRANSACTION RECEIPT 225 Firth
541.726-3753
OREGON 811-SPR2014-00150
www spnngfield-or gov 544 S 46TH ST permitcenter @spnngheld-or gov
RECEIPT NO: 2014000165 RECORD NO: 811-SPR2014-00150 DATE:0112412014
DESCRIPTION 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
PAYMENT TYPE PAYOR CASHIER:JLARSON COMMENTS AMOUNT PAID
Check Marc Stebbeds 93.60
512
TOTAL PAID: 93.60
Mechanical Permit Application DEPARTMENT USE ONLY
SPRINGFIELD -
CITY OF SPRINGFIELD, OREGON Permit no.:(2)[ \ 2.,0\3 COI 5
225 Fifth Street • Springfield,OR 97477 •PH(541)726-3753 • FAX(541)726-3689 tii' Date: //23 //v
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 _
❑ Residential El Government 1 ❑Commercial Residential Qty. Cost Total
JOB SITE INFORMATION AND LOCATION First Appliance , $80.00 $
Job site address: � Co Furnace/burner including ducts and vents
�.,}4,\, Stater [ ZIP:�'(�Li Up to 100k BTU/hr. $18.50 S
City: j�' Over 100k BTU/hr. $22.00 S
Reference: Taxlot.: -
DESCRIPTION Heaters/stoves/vents
ESCRIPTION OF WORK
Unit heater $18.50 5
j�p f`G T ` t.iS i i _ ;14 Wood/pellet/gas stove/flue / $42.00 $
/ T Repair/alter/add to heating appliance/
refrigeration unit or cooling system/ $80.00 S
PROPERTY OWNER - absorption system
Name: P 0 `a Evaporated cooler $14.50 S
Address: eee t 1A,t("CO Lit, �.0 Vent fan with one duct/appliance vent $10.00 S
A rr I /1‘74/?8 Hood with exhaust and duct $14.50 $
City: f( t l� State:f� ZIP: Floor furnace including vent $80.00 $
Phone:.(/ 2/6� 99/ Fax: - - Gas piping
E-mail: One to four outlets $7.50 $
This installation is being made on pr.--rty owned by me or a Additional outlets(each) $4.50 $
member of my immediate family, -. . is e -mpt from licensing Air-handling units,including ducts
requirements de ORS 701.0 w"family, , Up to 10,000 CFM $12.00 $
Signature: �l����' Over 10,000 CFM $22.00 $
C NTR. CTOR INSTALLATION Compressor/absorption system/heat pump
Business name: I)c�V1 1 4. z 1...„,-doelyi-rcr,41:;,. Up to 3 hp/I OOk BTU $18.50 $
Address: 305"SI5�` ..t,I.< /4/4i / Up to 15 hp/500k BTU $32.00 $
_ rte' Up to 30 hp/1,000 BTU $47.50 $
City; 6�G y State:OR ZIP: 7 /o5" Up to 50 hp/1,750 BTU $62.50 $
Phone:574/ - S-eQ 7�.5cFax: - - Over 50 hp/1,750 BTU $104.50 $
E-mail: Incinerators
�9 Domestic incinerator $22.50 S
CCB license no.: Commercial
Print name: Enter total valuation of mechanical system
and installation costs$
Signature: Enter fee based on valuation of mechanical system,etc. $
Miscellaneous fees Items Cost Total
ea. cost
Reinspection $80.00
Specially requested inspections(per hr.) 580.00 $
Regulated equipment(unclassed) $14.50. $
Each additional inspection:(1) $80.00 , S
APPLICANT USE
(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]) S
(D)Seismic fee, 1%(.01 x[A]) $
(E)Technology Fee(5%of[A]) $
440-2545-J(4/1/2013/COM) TOTAL fees and surcharges(A through E): 5 73 Lpf
3