HomeMy WebLinkAboutPermit Mechanical 2014-3-6 SPRINGFIELD- 225 Fifth St
CITY OF SPRINGFIELD • Springfield,OR 97477
C ` Phone: 541-726-3753
OREGON Building / Commercial Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
- PERMIT NO: 811-SPR2014-00487
www.springfield-or.gov permitcenter @springtleld-or.gov
PROJECT STATUS: Issued ISSUED: 03/06/2014 EXPIRES: 09/02/2014
•
STATUS DATE: 03/06/2014 APPLIED: 03/05/2014
SITE ADDRESS: 110 MAIN ST,Springfield, OR 97477 SCOPE: Mechanical Only •
ASSESOR'S PARCEL NO: 1703353204300 TYPE OF STRUCTURE: Commercial
•
PROJECT DESCRIPTION: Gas furnace installation
OWNER: CARLSON RICHARD C &WINONA J Phone Number:
ADDRESS: 1155 T ST
SPRINGFIELD OR 97477
CONTRACTOR INFORMATION
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
Mechanical Contractor PRIORITY ONE HEATING&AIR CONDITIONING INC CCB 154686 03/30/2015 541-689-1004
•
INSPECTIONS REQUIRED
Inspections
•2255 Gas Pressure Test •
2300 Rough Mechanical Rough Mechanical: Prior to Cover
2310 Rough Gas Rough Gas: After line is installed and required testing and capped if not attached to •
an appliance.
2995 Final Gas Final Gas: When all gas work is complete. •
•
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.
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V• - 1-
05 nnW V.. •
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Owner or Contractor Signature «l Date•
NOTICE: ATTENTION: Oregon law requires you to
• follow rules adopted by the Oregon Utility
THIS PERMIT SHALL EXPIRE IF THE WORK 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 3/6/2014 8:31:33AM Page 1 of 1
SPRINGFIELD CITY OF SPRINGFIELD
1 t1 -�rasi. � 225 Fifth St
TRANSACTION RECEIPT Springfield,OR 97477
sLirl 541-726-3753
OREGON 811-SPR2014-00487
www.spnngfield-or.gov . 110 MAIN ST permitcenter @springfield-or.gov
RECEIPT NO: 2014000501 RECORD NO: 811-SPR2014-00487 DATE: 03/06/2014
[DESCRIPTION - - - -
ACCOUNT CODE/TRANS CODE_ AMOUNT DUE,
Mechanical Permit fee (based on value of work) 224-00000-425604 1006 224.56
State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 26.95
Technology fee (5%of permit total) - 100-00000-425605 2099 11.23
TOTAL DUE: 262.74
LPAYMENT TYPE PAYOR ;CASHIER:JLARSON _ , _'Y_ -COMMENTS ` _ `_ AMOUNT PAID _"- . _ 1
Credit Card Priority One Heating 262.74
•
01517G
TOTAL PAID: 262.74
Mar 05 14 04:40p Priority One Heating 5416074457 p.2
Mechanical Permit Application DEPARTMENT USE ONLY
5V81NGf
CTfY OF SPRINGFNLDI,`;10R1�GOlY Permit no ' f�1�- L?L[. `{-r"(
'
225 Filth Str-.t • Springfield,OR 97477 • PH(540726 3753 • FAX 541)72G 36x9 [I JxlGOH Date: -9( ,c I
This permit is issued under OAR 918-140-0050. 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 I;j Commercial Residential Qty. Cost
Total
ea. cast
JOB SITE INFORMATION AND LOCATION First Appliance $80.00 .$
Job site address: ( I Imo': 1„1 (/4_;_.; Jt rase I- Furnace/burner including ducts and vents
City_Spi i Ft.'"-I--[._,1r'1 State: '`-ice I ZIP: : 7:-1;11
lip to I OOk BTU/hr. 1 $18.50 S
1 Over look BTU/hr. $22.00 S
Reference: 1 Taxlot.:
Heaters/staves/vents
DESCRIPTION OF WORK Unit heater $18.50 $
i!'Z` i=~II 1VV.L1,..1 7'.UL 7-.C.(` r!i.i/-1 'p g $42.00 $
{ ( -) � � t `-C. µ'00d, ellcl/ ai stove/flue
L )F'1• \ 11 ...0 L-9 "c Repair/alter/add to heating appliance/
Y LL]�` i� ' refrigeration unit or cooling system' $80.00 $
PROPERTY OWNER absorption system
Name: I('t, -i;:LA )L ' CL V I
( '5 -i 1 Evaporated cooler $14.50 $
-1-- Vent fan with one ductiappliance vent $10.00 $
Address: "t I `i- - :,',I ,
Hood with exhaust and duel $14.50 $
City:`-f-ADIL, . State: j j_ ZP: C (�71
Floor furnace including vent $80.00 $
Phone:' --F[ =iCt(r_Jtj 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. lip to 10,000 CFM $12.00 $
Signature: Over 10,000 CFM . $22.00 S
CONTRACTOR INSTALLATION Compressor/absorption system/heat pump
'i- Up to 3 hp/I ODk BTU I $18.50 .$
Business name: it)/[(.:r'1 -(--L. l:•[-L1. [16';';:c(-71 1' 1 i
(- _ �„ Up to 15 hp/500k BTU $32.00 S
Address�-I)3 1ti UCrl-1r `i,;"i•,(v E. '71F. I i t 4; C( ( Up to 30 hp/1.000 BTU 547.50 3
city: 1 State: Q IZ ZIP: L1 %-ici,-- Up to 50 hp/l.750 BTU S52.50 $
Phone:' {-I Ls j-1- E,r;C'4 Fax: 56"4.1 etc-7. = 7_(; Over 50 hp/1.750 BTU $104.50 $
E-mail:`ihC-e,:?. (C irtTtV.5 '2,;-1C:,tt1ct\..i•' -;:-,o Incinerators
- v r v Domestic incinerator 522.50 $
CCB license co.: ( `m�(✓•'1 Cc
c, _ Commercial
Print name: 1:: \6 C it L ti it I'jtD- i f t5 Enter total valuation ofinechanical system
Signature: :�•)Lii-.LL L r;T, K. C+(�['j'J-<\
and installation costs$ /=..'7',,:(.t
Enter fee based on valuation of mechanical s •sten,etc. $
Miscellaneous fees Items Cost Total ':
ea. cost •
Reinspection $80.00 $
Specially requested inspections(per hr.) $80.00 $
Regulated equipment(nnclassed) $14.50 $
Each additional inspection: (I) $80.00 $
APPLICANT USE
(A)Enter subtotal of above rtes(or enter set
minimum fee of $80_00) $ •
(B)Investigative tee(equal to[A]) $
(C)Enter 12%surcharge(.12 x[A4-B]) $
(0) Seismic ice, I%(-01 x[A]) $
(E)Technology Fee(5%of[A]) $
440-25455-1(4/1/20131 OM) TOTAL fees and surcharges(A through E): $2-62-