HomeMy WebLinkAboutBuilding Application 2014-2-12 02/11/2014 08: 57 FAX 541 607 0287 e10001/0014
Mechanical Permit Application DEPARTMENT USE ONLY
_ - SPRINGFIELDbur^
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Permit 1 ) �— J
= 7a ,i, s � ` i aa L v c $1:
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225 FllTh Street • Springfield,OR 97477 • F11(541)726-37,53 • FAX(541)726.3659 }° ,SOatGo0 Date: 2// 2- ( /`(
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 ❑Government Residential Qty. Cost Total
1 — _ ea. cost
JOB SITE INFORM'TION AND LOCATIONNI F,st A I Inmtce $80.00 $
Job site address' yawl,14,x4 o' -*��41 • 4 �'' 111'uaceNw•net Including ducts and vents
City' _ J% g2 a � zip:/- — Up to 100k BTU/hr. $10.60. $ __
Over 100k BTU/hr; $22.00 $
Reference: /7)7 X31(7 Taxiot.: Vo9p Heaters/stoves/vents
DESCRIPTION OF WORK Unit heeler $18.60 $
• 1.0 I e I a ' ii - - 4,y Wood/pellet/gas stove/tine $42.00 ,$
Repair/niter/add to heating appliance/
refrigeration unit or cooling system/ $80.00 $
PROPERTY OWNER absorption system
Nance: L% �.a _.,.' .�_ i�Iy•/'. P ILd Evnpu tiled cooler. _ -^..- .c14.50 $
Address: ♦ ,: Vent fan with one duct/appliance vent $10.00 $
ASV iii_Ain. , i
• e 1 Hood with exhaust and duct $14.60 ,$
City: �A( State:4j ZIP:S dr Floor furnace including vent $00.00 $
Phone: - - Fax: - - Gas piping
E-mail: One to four outlets $7.50 $
This installation is being made on property owned by me or a Addltiunal 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: Over 10,000 CFM $22.00 $
CONTRACTOR INSTALLATION Compressor/absorption system/heat pump
Business_rm_ne; r L Up to 3Ili/100k BTU __$18.60 $
l (,I(t ✓,� 'f1�/A'11/ � Up le 15 hp/500k BTU $32.00 $
Address:��330 .°l r1 [�1 Up 30 hp/1,000 BTU $47.50 $
City i�11' ytp State:. \ LZIP:g7�Q Z Up to 50 hp/1,750 BTU -- 562,50 $
Phone: 4 1Lg( 3 '-01--5-9 6 Fax: J-607- 6,,2_,E} Over 50 hp/1,750 BT'U $104.60 .$
E-nnall167" - 1)Q-SSalae h/G-li. 144, ._incinerators ._....._..-----
- Domestic incinerator $22_50 L $ --
CCF3license no.: /&b .2� _—,.— Commercial _Print nanle:4�4 & fly7 f(.vr _ Enter total valuation of nnceJ�Inn�capl s stem _
Signalun• mil'' _ - �, and installation costs$—Kdr19 / J?el 01
- - Enter fee based on valuation of mechanical System etc. $
Miscellaneous fees Items frost Total
en, cost
Relnspeetion- $80.00 $
Specially requested inspections(per hr.) $80.00' • $
Regulated equipment Outclassed) $14.60 $
Each additional Inspection:(I) $80.00 $
APPLICANT.'USE
(A)Enter subtotal of above lees(or enter set /
minimum fee of $80,0Q) $ /7/c0
(B)Investigative fee(equal to[A)) $
(C)Enter 12%surcharge(.12 x[A+e)) $ rr10
(D).Seismic fee, I%(.01 x[A]) $ (/�_i
(E)Technology Fee(5%of[A)) $ l✓
440-2545.1(4/I/2013/COM) TOTAL fees and surcharges(A through E): $ 15
SPRINGFIELD _._
225 Fifth St
• CITY OF SPRINGFIELD Springfield,OR 97477
` m"{ i 4 - Phone: 541-726-3753
l OREGON Building / Commercial Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2014-00311
www.springfieldor.gov permitcenter @springfield-or.gov •
PROJECT STATUS: Issued • ISSUED: 02/12/2014 EXPIRES: 08/11/2014
STATUS DATE: 02/12/2014 APPLIED: 02/12/2014
•
SITE ADDRESS: 5608 MAIN ST,Springfield,OR 97478 SCOPE: Mechanical Only
ASSESOR'S PARCEL NO: 1702334103000 TYPE OF STRUCTURE: Commercial
PROJECT DESCRIPTION: Replace gas package unit
OWNER: PSMMR LLC Phone Number:
ADDRESS: 3474 SPRING BLVD
EUGENE OR 97405
CONTRACTOR INFORMATION
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
Mechanical Contractor ASSOCIATED HEATING&AIR CONDITIONING INC CCB 106275 08/31/2014 541-683-2590
INSPECTIONS REQUIRED
Inspections
2300 Rough Mechanical Rough Mechanical: Prior to Cover
2999 Final Mechanical Final Mechanical: Wien 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 Contractor Signature Date
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Springfield Building Permit 2/12/2014 12:24.13PM Page 1 of 1
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SPRINGFIELD CITY OF SI'RINGFIELD
225 Fifth St
tt TRANSACTION RECEIPT Spnngfleld,OR97477
9 OREGON 541-726-3753
811-SPR2014-00311
wwwspringfield-or.'gov 5608 MAIN ST permitcenter @springfield-or.gov
RECEIPT NO: 2014000297 RECORD NO: 811-SPR2014-00311 DATE:02/12/2014
LDESCRIPTION ACCOUNT CODE/TRANS CODE__.. _ AMOUNT DUE'
Mechanical Permit fee(based on value of work) 224-00000-425604 1006 131.63
State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 15.80
Technology fee(5%of permit total) 100-00000-425605 2099 6.58
TOTAL DUE: 154.01
LPAYMENT�TYPE PAYOR CASHIER:CCARPENTER • COMMENTS - _ _ `AMOUNT PAID., .
Credit Card ASSOCIATED HEATING &AIR 154.01
06670j CONDITIONING INC KEVIN BROOKE
TOTAL PAID: 154.01