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Home My WebLink AboutPermit Mechanical 2014-4-11 SPRINGFIELD 225 Fifth St t CITY OF SPRINGFIELD Springfield,OR 97477 OREGON Phone: 541-726-3753 . Building I-Residential Permit Inspection Phone: 541-726-3769 Fax: 541-726-3676 PERMIT NO: 811-SPR2014-00778 www.springfield-ar.gov permitcenter @springfield-or.gov PROJECT STATUS: Issued ISSUED: 04/11/2014 EXPIRES: 10/08/2014 • STATUS DATE: 04/11/2014 APPLIED: 04/11/2014 • SITE ADDRESS: 1125 58TH ST,SPC#47,Springfield,OR 97478 SCOPE: Mechanical Only ASSESOR'S PARCEL NO: 1702342200100 TYPE OF STRUCTURE: Residential • PROJECT DESCRIPTION: Replace Furnace OWNER: BAILEY THELMA JEAN Phone Number: ADDRESS: 1125 N 58TH ST SPACE 47 SPRINGFIELD OR 97478 66 - CONTRACTOR INFORMATION 1 Contractor Type Contractor Name. Lic Type Lic No Lic Exp Phone Mechanical Contractor DEAN M SHULTZ CCB 183169 08/09/2014 541-556-7862 I INSPECTIONS REQUIRED 1 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 permissio •f the Community Services Division, Building Safety. I further certify that only contractors and employees who are in comp/'=nce with ORS 701.005 will be used on this project. I further agree to ensure that all required inspections are.requested at the .roper time, that each address is readable from the street, that the p- it •:rd is located at the front oft 'property, and the -.pp oved set of plans will remain on the site at all times during •ns u•io or ie / Asa 7- wr- Owner or Contractor Signature J 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 AUTHORIZED UNDER THIS PERMIT IS NOT • In OAR 952-001-0010 0010 through OAR e9 rules b COMMENCED OR IS ABANDONED FOR calling the center. (Note: the telephone'by ANY 180 DAY PERIOD. number for the Oregon Utility Notification Center is 1-800-332-2344). • • Springfield Building Permit 4/11/2014 12:45:00PM Page 1 of 1 • SPRINGFIELD CITY OF SPRINGFIELD 225 Filch St t ;, TRANSACTION RECEIPT Springfield,OR97477 OREGON r 541-726-3753 811-SPR2014-00778 www.springfield-or.gov 1125 58TH ST. SPC 47 permitcenter @sphngfield-or.gav RECEIPT NO: 2014000785 RECORD NO:811-SPR2014-00778 • DATE:04/11/2014 for ithlWidluki..t "u +,P.Si r akWELSALI .e ti:ACCOUNiT;CODEJ RANS7CODE ;# &ti AMOUNT'DUEic First Appliance Fee 224-00000-425604 1006 I 80.00 State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 I 9.60 Technology fee(5%of permit total) 100-00000-425605 2099 4.00 TOTAL DUE: 93.60 AYME35-TiLP,Er` P.AYOirrrienSHIeR:Iccgaaexre "'' COMMEN7s TA ffar- ,Ta;.ICAMOUNT,DID;1 Cash DEAN M SHULTZ 93.60 1 'TOTAL PAID: 93.60 • 1 Mechanical Permit Application DEPARTMENT USE ONLY SPRINGFIELD C OFirSPRING rI LD,=®REG®N . Permit no.:SP/�t c/ — 0077S Oran (( i" .. 225 Fifth Street ♦ Springfield. 97477 ♦ PH(541)726-3753 ♦ I X(5411726 r689 ,' "5.‘Qg 61��/ OREGON Date: I tr 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 ISO days. CATEGORY OF CONSTRUCTION FEE SCHEDULE El Residential El Government ❑ Commercial Residential Qty. Cost Total ea. cost JOB SITE INFORMATION AND LOCATION First Appliance 1 580.00 $ Job site address: i 1 I SCS-t\r- 51 tp C47— Furnace/burner including duets and veins City: iD(� ( t E'k& State: Q� 711': 1 71-01( Up m I00k 13111/hr. $10.50 S Over I00k 13IU/hr. 522.00 5 Reference: '" Tax lot.: — Heaters/stoves/vents DESCRIPTION OF WORK Unit heater $18.50 $ Wood/pellet/gas stove/flue $42.00 $ • Repair/alter/add to heating appliance/ refrigeration unit or cooling system/ $80.00 S PROPERTY OWNER absorption system Name (;y I Evaporated cooler $14.50 S Address: R l t$ S Q t A.S t� � ( G(,e. C( (, \'cal fan with one duel/appliance vent $10.00 $ / Hood with exhaust and duct $14.50 $ City: S(��,�, Et�-\� Slate: ZIPq�C(�;Y floor furnace including vent $80.00 $ Phone:5(1 -k,- l b D 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 S 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 / 512.00 $ Signature: Over 10,000 CFM $22.00 $ • CONTRACTOR INSTALLATION Compressor/absorption system/heat ptunp 0 00\ S l to\�� _ Up to 3 hp/100k BTU $18.50 $ Business name: J Ilp to 15 hp/500k BTU $32.00 S � Address: , 3 l- Up to 31)hp/I,000 BTl I $47.50 $ City: C(LS„) .0\ Stale: o \L "LIP: e1 i L(� Up na 50 hp/1.750 BTU ----$62.50 Phone5U[ - - n(0 L Fax: . - - Over 50111)/1.750 BTU $104.50 $ E-mail: Incinerators CA C Domestic incinerator $22.50 1 51 CCB license no.: \CC 3 \b 1 1 Commercial Print name: �v`n`7` Skt1 Enter total valuation of mechanical system and insmlhuion costs$ Signattee �//� _ Enter fee based on valuation of mechanical system.etc. S - Miscellaneous fees Items Cosl Total ca. cost Reinspection $80.00 S _ 1, Specially requested inspections(per hr.) $80.00 S Regulated equipment(unclassed) $14.50 $ Each additional inspection: (I) 580.00 S APPLICANT USE (A)latter subtotal of above fees(or enter set minimum fee of $80.00) $ (B) In vest igat i ve fee(equal to[Al) S (C) Fitter 12%surcharge(.12 x IA+131) $ (D)Seismic fee. 1%(.01 x [A]) $ (F)Technology Fee(5%of[Al) $ 4.10-2545-1(-I/12013/CObli TOTAL lees and surcharges(A through E): S 7j_��