HomeMy WebLinkAboutPermit Mechanical 2014-4-14 •
SPRINGFIELD 225 Fifth St
` ' _ ,• CITY OF SPRINGFIELD Springfeld,OR 97477
-K edi OREGON Phone: 541-726-3753 •
Building / Residential Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2014-00785
www.spring(eld-or.gov permitcenter @springfield-cr.gov
PROJECT STATUS: Issued ISSUED: 04/14/2014 EXPIRES: 10/11/2014
STATUS DATE: 04114/2014 APPLIED: 04/14/2014
SITE ADDRESS: 1236 JANUS ST,.Springfield,OR 97477 - SCOPE: Mechanical Only
ASSESOR'S PARCEL NO: 1703342200208 TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: Relocate gas outlet for range •
OWNER: KIMBALL THERESA M 8 GEORGE C Phone Number:
ADDRESS: 1236 JANUS ST •
SPRINGFIELD OR 97477
CONTRACTOR INFORMATION
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
Mechanical Contractor OWNER CCB 000000 08/01/2025
• INSPECTIONS REQUIRED N
Inspections
2255 Gas Pressure Test 2-
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
construe, .
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Owner or ontractor Sig =ture Date
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ATTENTION: Oregon law requires you to
NOTICE: r 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
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 4/14/2014 10:59:11AM Page 1 of 1
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SPRINGFIELD CITY OF SPRINGFIELD
225 Fifth St
,#t" TRANSACTION RECEIPT Springfield,OR 97477
OREGON 541-726-3753
811-S PR2014-00785
www.springfield-or.gov 1236 JANUS ST permitcenter @spnngfield-or.gov
RECEIPT NO: 2014000791. RECORD NO:811SPR2014-00785 DATE:04/14/2014
Fri x`5'-i -G'I n rv)F-r �,'E 4i ^t' + ,.. 1 -.n.n rn q_.. .- ..�
(DESCRIPTION,,. �-s�av�3��- �«.rf,�«11r,b..-��s�#'s,1 t=�:�+�ii4.91;ugCCOUNS{'CODEI.T;RANS';CODEa�I:;a�-�?7�,�,�AMOUNT�DUEi:w
• First Appliance Fee 224-00000-425604 1006 80.00
Gas Piping up to 4 outlets 224-00000-425604 1006 7.50
State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 10.50
Technology fee(5%of permit total) 100-00000-425605 2099 4.38
TOTAL DUE: 102.38
.k.,-._ .,• — 7,67ii. , , . 21n511 ..i�AMOUNTPAIDr��* �i-i ?? ``�=
I�",PAYMENT+T,YP.E+� j1�PAYORt'.�CASHIER.,CCARPENTER�`,��,�,fi,COMMENI'S�.a-�"'i'.r=. r.�.t'd,t, v.�. ... --.3� x ..A�k
Credit Card KIMBALL THERESA M &GEORGE C 102.38
493645
TOTAL PAID: 102.38
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Meehanical Permit Application DEPARTMENT USE ONLY
a SPRINGFIELD
CIa 0Y OF SPRINGFIEED-OREG'O -- > r Permit no.:
FAN(541)726-3689 S/Y -
85
' ' , s A
225 Filth Street • Span-field,OR 97-177 • PH(54I)726-3713 r° , p; Date: K(/C/ (/11
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
'1esidential El Government ❑Commercial Residential Qty. Cost Total
ea. cost
JOB SITE INFORMATION ANDLOCATION First Appliance / S80.00 $
Job site address: /_3 3,4/u0 S G ( Furnace/burner including ducts and vent
City: 3.0-0 n �d State: Q ft ZIP:9t 7�/ Up to l00k n)Ufhr. $18.50
Jf/' ( Over 100k 131U/hr. $22.00 $
Reference.• Taxlot.:
Heaters/stoves/vents
DESCRIPTION OF WORK Unit healer $18.50 $
CA_ .. w r_ i- '�. �` _ , - t 4 wood/pellet/gas stove/flue $42.00 $
� Repair/alter/add to heating appliance/
it C . • / • J U t 1 •P refrigeration unit or cooling system/ $80.00 $
II PROPERTY OWNE• absorption system
Name: 5enj7 e. rY I 4, ) / Evaporated cooler- £14.50 $ _ZJ
Tess 3 - -�-� Vent Ian with one duo/appliance vent $10.00 $
Address: I s-, x-40 /J S 5'
L �n Hood wish exhaust and duct $14.50 $
City: /�n tN - dSlale. �< ZI P:g7✓ �
Floor furnace including vent $80.00 S
Phone: I -c4±±413 eiT .g- - Gas piping
E-mail _1t-_7_a One to four outlets i $7.50 $2
This installation is being n ,d n 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 512.00 $
Signature: Over 10.000 CFO 522.00 $
CONTRACTOR INSTALLATION . Compressor/absorption system/heal pump
Business name: ��, r,/1 O/� _--, Up l03 hp/look U"flJ $18.50—_-R
.(/ I Up to I d hp/500k BTU $32.00 $
Address: Up to 30 hp/I.000 I3TU $47.50 $
City: State: ZIP: Up to 50 hpr1.750 BTU $62.50 $
Phone: - - Fax: - - Over 50 hp/1.750 BTU $104.50 $
E-mail: Incinerators _--
---- Domestic incinerator $22.50 $
CCB license Ito.:
-------- Commercial
Print name: Enter total valuation of mechanical system
and installation costs$
Signature:
Enter fee based on valuation of mechanical system.etc. $
Miscellaneous fees Items Cost 'Fond
ea. cost
Reinspcctioo $80.00 $
Specially requested inspections(per hr.) $80.00 $
Regulated equipment(unclassed) $14.50 $
• Each additional inspection: (I) 580.00 $
APPLICANT USE
(A) Enter subtotal of above fees(or enter set
minimum fee of $80.00) $
(B) Investigative fee(equl to[A]) $
(C) Enter 12%surcharge(.12 x IA+Bp $ b 7
(D) Seismic fee. 1%(.01 x IA]) $
(13)Technology Fee(5%of(Al) $ 117
440-2545-i(4/I/2013/COM) TOTAL Ices and surcharges(A through E): $ /07