HomeMy WebLinkAboutPermit Mechanical 2014-3-11 •
SPRINGFIELD 225 Fifth St
CITY OF SPRINGFIELD Springfield OR 97477
\et, 4r Phone: 541 726-3753
ONEGON Building / Commercial Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2014-00521
www.springfield-or.gov permitcenter @springfield-or.gov
PROJECT STATUS: Issued ISSUED: 03/11/2014 EXPIRES: 09/07/2014
STATUS DATE: 03/11/2014 APPLIED: 03/11/2014
SITE ADDRESS: 1613 MAIN ST,Springfield,OR 97477 SCOPE: Mechanical Only
ASSESOR'S PARCEL NO: • 1703363104800 TYPE OF STRUCTURE: Commercial
PROJECT DESCRIPTION: Install Ductless Air cond. in air dryer room
OWNER: CENTURYLINK Phone Number:
ADDRESS: ATTN TOM VIBBER ND#005.32
LITTLETON CO 80120
CONTRACTOR INFORMATION
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
SOURCE REFRIGERATION 8 HVAC INC (C)Electrical Cant C546 07/01/2014 714-578-2341
INSPECTIONS REQUIRED
• Inspections
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 an. - ployees who are in compliance with ORS 701.005 will be used on this project. I further agree
toe.:. - hat all required i ons are requested at the proper time, that each address is readable from the street,that the
• rmit care is located at t of the property, and the approved set of plans will remain on the site at all times during
constructs.n.
•
Ow - or Contra tSi.!ature Date
ATTENTION: Oregon law requires you to NOTICE:
follow rules adopted by the Oregon Utility • THIS PERMIT SHALL.EXPIRE IF THE WORK
Notification Center. Those rules are set forth
in OAR 952-001-0010 through OAR 952-001- AUTHORIZED UNDER 'fHIS PERMiT'IS NOT
0090. You may obtain copies of the rules by COMMENCED OR IS ABANDONED FOR
calling the center. (Note: the telephone ANY 180 DAY PERIOD.
number for the Oregon Utility Notification
Center is 1-800-332-2344).
Springfield Building Permit 3/11/2014 1.17:09PM Page 1 of 1
•
j SPRINGFIELD • CITY OF SPRINGFIELD
225 Fifth St
TRANSACTION RECEIPT Springfield,OR97477
OREGON 541-726-3753
811-SPR2014-00521
www.spnngfield-or.gov 1613 MAIN ST permitcenter @springfield-ar.gov
RECEIPT NO: 2014000534 RECORD NO: 611-SPR2014-00521 DATE:03/11/2014
rDESCRIPTION, ACCOUNT CODE/T,RANS CODE "__ ,,_ • _AMOUNT.DUE _ t
Mechanical Permit fee(based on value of work) 224-00000-425604 1006 141.96
State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 17.04
Technology fee(5%of permit total) 100-00000-425605 2099 7.10
TOTAL DUE: 166.10
AMOUNT PAID
PAYMENT,TYPEPAYOR_-_ CASHIER ccnRPERrers, _ s COMMENTS _ _
Credit Card SOURCE REFRIGERATION & HVAC I _ 166.10
04346G
TOTAL PAID: 166.10
•
•
•
•
•
•
•
•
Mechanical Permit Application DEPARTMENT USE ONLY --
zf ip vi^� _a.•ec t, SPRINGFIELD
# rr r - ` si`S rY b -,..� x-,..£ .Tr mss? n a' ra �`g=� .s,wi.' r ILZPJI OtC2-i
�`CITTiV� .nO SPRINy,G� IELDift,ORE6ON` S w, Permit no.: y —
9 .4Rt74,rp.a,aa k r . ZrvLtire 4 1wMdiC. r53-.."-.7,-.!%ttem:kfi -1
225 Fifth Street• Springfield,OR 97477 • PH(541)726-3753 • FAX(541)726-3689 ,:' Witt - Date: 3/0 //L/
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.
..'; '1"v 2Y,OATEGORY .6GOliNSTRUCT.ION , ...?4.3 .„4;;;;. �a.�.t.: 5 .t .. . as ;... r 4
,- ri + r' FEE �SCHEOULE,� r:. ti vrx=4”
+K !,h Y`3 k �. : 5 �Y„; . {5 -specn$t "-.Total 'L
❑ Residential' ❑Government %Commercial ,PResldential ?rkliz i Qty.'t lea+ ` ?3;c.-.-a
t`'JOK$117gAST,P13.MO 0914.4 ANO &OCATION.s:gV First Appliance $80.00 $
Job site address: / L 13 /1(ti},,, 5
/- Furnace/burner including ducts and vents
City: /PR 1, is /r) State: 02 ZIP:/941, Up to 100k BTU/hr. $18.50 $
/ �/ Over 100k BTU/hr. $22.00 $
Reference: Taxlot Heaters/stoves/vents
w=„,"jy' DESC/�RIPTION _QFfWO efrit aViatz* Unit heater $18.50 $
Ly`CA4/] £O.c//cSS at it e isne,42 Wood/pellet/gas stove/flue $42.00 $
/ A /�� L lee”' Repair/alter/add to heating appliance/
1 { +. �/ M l n„t refrigeration unit or cooling system/ $80.00 $
-: ',os3 4,,, ,j; ROP, TY,,t,OWNERx{�;-; tgilty``,k_. absorption system
Name: e_a,r 1,< Z. y, /2 Evaporated cooler ' $14.50 $
Address: ` ` - Vent fan with one duct/appliance vent $10.00 $
// /^ �A{" Hood with exhaust and duct $14.50 $
City: ,1rt cJf-r id State° 2 ZIP:gf 7 yyf Floor furnace including vent $80.00 $
Phone: 1 -204- 346.._ yy7L 1�Fax: -""" ��/- Gas piping
E-mail: L.`5A, et/C Rn!F Cen C .1. iidD er One to four outlets $7.50 $
This installation is being fnade 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: Over 10,000 CFM $22.00 $
,
r?i] r zg�;,jcfNTRACTORl[NsTALLATION4 az Compressor/absorption system/heat pump
Business name: �� /' Up to 3 hp/100k BTU $18.50 $
�b r-,rL c_ "P,�P-a c✓'t-4-. n
Address: Up to 15 hp/500k BTU $32.00 $
�'(O L D rz.a et jc-mret c Up to 30 hp/1,000 BTU $47.50 $
City: 14i/A.IL.,a , State:t=/9- f ZIP:9Z5e/ Up to 50 hp/1,750 BTU $62.50 $
Phone:S52= 9 yZ Fax: - - Over 50 hp/1,750 BTU $104.50 $
E-mail: 7,44,47h ,es Q' co_._c-eg ; a47(,04icop? Incinerators
Domestic incinerator $22.50 $
CCB license no.: yr/ at O .; �a ;�} .xi
Comme�cal ,,,z ��n*�2^ ,. 3 Y.,, ��,;
Print name: W,vi 44/x ncie S Enter total valuation of mechanical system 7f7.20 . Co
and installation costs$ .,00
Signature: T Enter fee based on valuation of mechanical system,etc. . $
r ;erm„n;, -° + ?kwvtot 1., ,.° - ,Cost Total`}
;M1!..V"392.011sgf,,ee5 ity a31:;nlz, t x...-'ea. cost',:
Reinspection $80.00 $(y/co
Specially requested inspections(per hr.) $80.00 $
Regulated equipment(unclassed) $14.50. S
Each additional inspection:(1) $80.00 S
IS .,as KAPPLICANTUSE 1 _`35 v"s„ s
(A)Enter subtotal of above fees(or enter set
minimum fee of $80.00) $ /1 //f 1L
(B)Investigative fee(equal to[A]) $(C)Enter 12%surcharge(.12 x[A+B]) $ /7 0
(D)Seismic fee, 1%(.01 x [A]) $
(E)Technology Fee(5%of[A]) $ 7-
440-2545-1(4/12013/COM) TOTAL fees and surcharges(A through E): $ ('Qt
/&G /T