HomeMy WebLinkAboutPermit Mechanical 2014-3-17 I'
SPRINGFIELD 225 Fifth St
•t ' (a— CITY OF SPRINGFIELD Springfield,OR 97477
I } \OREGON Phone: 541-726-3753• Building / Residential Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO : 811-SPR2014-00563
www.springfield-or.gov perm itcenter @springfield-or.gov
PROJECT STATUS: Issued ISSUED: 03/17/2014 EXPIRES: 09/13/2014
STATUS DATE: 03/17/2014 APPLIED: 03/17/2014
SITE ADDRESS: 4795 FRANKLIN BLVD,SPC#40,Eugene,OR 97403 SCOPE: Mechanical Only
ASSESOR'S PARCEL NO: 1803022002900 TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: Replace furnace
OWNER: RUIZ LUCIO TOBON Phone Number:
•
ADDRESS: 4795 FRANKLIN BLVD SPACE 40
EUGENE OR 97403
CONTRACTOR INFORMATION
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Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
Mechanical Contractor DEAN M SHULTZ CCB 183169 08/09/2014 208-573-4714
INSPECTIONS REQUIRED
Inspections -
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. �-'���G
�,4
Owner or Contracto Signature Date •
• ATTENTION: Oregon law requires on Utilit
follow rules adopted by the Oreg y ,�ri CE: .
Notification Center. Those rules are set forth
in OAR 952-001-0010 in copies ofthe uses by �Ul ORI PERMIT SHALL
UNDER THIS PERM TEIS NOT
0090. You may OMMENCED OR IS ABANDONED FOR ,
calling the center. (Note: the telephone
number for the Oregon Utility Notification ANY 180 DAY PERIOD.
Center is 1-800-332-2344).
Springfield Building Permit 3/17/2014 2:20:03PM Page 1 of 1
SPRINGFIELD CITY OF SPRINGFIELD
225 Fifth St
::(Le ON TRANSACTION RECEIPT Springfield.OR97477
541-726-3753 •
811-S P R2014-00563
•
www.springfield-or.gov 4795 FRANKLIN BLVD. SPC 40 permitcenter @springfield-or.gav
RECEIPT NO: 2014000574 RECORD NO:811-SPR2014-00563 DATE:03/17/2014
DESCRIPTION _ • _ ` - _ACCOUNTCODE/TRANS CODE:; _ :__ AMOUNTDUE
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"_FA.YOR CASHIER:.c9AR?ENraR _ _- COMMENTS,v._,___ _w_._ :AMOUNTPAID ` _ _
Credit Card DEAN M SHULTZ 93.60
000660
TOTAL PAID: 93.60
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•
•
" Mechanical Permit Application DEPARTMENT.USE ONLY ;
Vitr ad,,H .ry5 .F•Z4yVye SPRINGFIELD .4"ru. 9v - 37 3
x,� GrrY O SPRINGFIELD OREGON , �, 1 x �, -: Permit no.:
-.-°c`. c ert3-„ "anti-�-c, -x� :5.x .,,,,a i-s.. ..rr.M_-e; `s s*xc s ���y *
225 Fifth Street• Springfield,OR 97477 • PH(541)726-3753 • FAX(541)726-3689 T*'-'~!;`' �A ' Date: .7/77 j, //
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' , „CATEGOR't of CONSTRUCTION '. '' " ,s;ir l ;a` rA FEE tt14 tiAiCalian.i-,:i.M4- ziAii
[Residential ❑Government ❑ Commercial `Y 'A : ft , ost , Total y
Residential > ,
, -�. k.�*!.-7 t�.,. Qty *:reap ,t...,a;tocost.,�:
' 'JOB SITEclNFORMATION AND iLOCATION:E;*
s :5 First Appliance $80.00 $
Job site address: U gib trtttgiitl BI(f(1 4,3 t' Furnace/burner including ducts and vents
City: r GYI� State:n R ZIP: q I yO3 Up to I00k BTU/hr. $78:50 $
Over look BTU/hr. $22.00 $
Reference: Taxlot
5 sv six Heaters/stoves/vents
r _ ,;l , DESCRIPTIONIOFe,WORK,; ,,r, ,• Unit heater $18.50 $
Figwcc.. R .p6ret&en+ Wood/pellet/gasstove/flue $42.00 $
Repair/alter/add to heating appliance/
_ refrigeration unit or cooling system/ $80.00 $
;a i riS PROPERTYOWNER x z r
absorption system
Name:(,t, j3 i,Vt l a LC Evaporated cooler $14.50 $
Address: 7 •5 'zl,i Bil; ), P 4b Vent fan with one duct/appliance vent ' $10.00 $
r Hood with exhaust and duct $14.50 $
City: tuei,c.e State: a?, ZIP: gc9o3
Floor furnace including vent $80.00 $
Phone:96 -716_mil 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 I $12.00 $
Signature: Over 10,000 CFM $22.00 $
.!aF.',;-CONTRA_ CTOR INS,Tr_ALLATIONta Aitt U Compressor/absorption system/heat pump
% I_ .-t CGXt� I Up to 3 hp/100k BTU $18.50 $
Business name: [ • II, 4, r 'I Up to 15 hp/500k BTU $32.00 $ig.
Address: �� cj( t-�
n�1 l� 17 /_ Up to 30 hp/1;000 BTU $47.50 $
City:! IC 101 ---(( State:op ZIP: ((4240 Up to 50 hp/1,750 BTU .$62.50 $
PhoneN - -7ci2 I Fax: - - Over 50 hp/1,750 BTU - $104.50 $
E-mail: Incinerators
CCB license no.: ��� i ,/Domestic incinerator t $22.50 $
(�,� 1� �aiiilRlercial .,.. .,dsk `'f :.,ltyn'S.' -_. r a r� i ip $v i l
Print name: ;e4);\ 4fyr'4` Enter total valuation of mechanical system
Q_ 'n I and installation costs$
Signature: ll/1JII
y Enter fee based on valuation of mechanical system,etc. $
Miscellaneous fees: y.iy tr ,,,, Items k,Cost Total iY ti, ti
;L �..,..4.sM ire. ._ �. .�.t�,.• ^G
Reinspection $80.00 $
Specially requested inspections(per hr.) $80.00 $
Regulated equipment(unclassed) $14.50. $
Each additional inspection:(1) $80.00 $
;ranw„ n .`APPLICANT USEva °4"-'' it z '
(A)Enter subtotal of above fees(or enter set
minimum fee of $80.00) $ k
(B)Investigative fee(equal to[A]) $
(C)Enter 12%surcharge(.12 x[A4-B]) $ gO
(D)Seismic fee, 1%(.01 x[A]) $
(E)Technology Fee(5%of[A]) $ J�_
440-2545-1(4/1/2013/COM) TOTAL fees and surcharges(A through E): $ q?e