HomeMy WebLinkAboutPermit Building 2014-4-17 SPRINGFIELD 225 Fifth St
11 °- i CITY OF SPRINGFIELD Springfield,OR 97477
v Phone: 541-726-3753
.: OREGON Building I Residential Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2014-00836
www.springfield-or.gov permitcenter @springfield-or.gov
PROJECT STATUS: Issued ISSUED: 04/17/2014 EXPIRES: 10/14/2014
STATUS DATE: 04/17/2014 APPLIED: 04/17/2014
SITE ADDRESS: 1566 16TH ST,Springfield,OR 97477 SCOPE: Pellet Stove/Insert
ASSESOR'S PARCEL NO: 1703253101700 TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: Pellet stove
OWNER: GERALD L&MARIE I UPSHAW REV TRUST Phone Number:
ADDRESS: 90901 LA LONE RD
SPRINGFIELD OR 97478
L CONTRACTOR INFORMATION
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
Mechanical Contractor OWNER CCB 000000 08/01/2025
INSPECTIONS REQUIRED
•
Inspections
2140 Pellet, Gas, Fireplace or Wood Wood Stove: After Installation.
Stove
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 oft - property, and the approved set of plans will remain on the site at all times during
construction.
0 /
k r or ontractor Signature - Date
ATTENTION: Oregon law requires you to
follow rules adopted by the Oregon Utility • .OTICE:
Notification Center. Those rules are set forth THIS PERMIT SHALL EXPIRE IF THE WORK
0090.OAR You may obtain copies OAR 952es by AUTHORIZED UNDER THIS PERMIT IS NOT
0090. You may obtain copies of the rules by
calling the center. (Note: the telephone COMMENCED OR IS ABANDONED FOR
number for the Oregon Utility Notification ANY 180 DAY PERIOD.
•
Center is 1-800-332-2344). -
Springfield Building Permit 4/17/2014 8:47:34AM Page 1 of 1
SPRINGFIELD CITY OF SPRINGFIELD
, .4a... 225 Fifth St
Ct TRANSACTION RECEIPT Springfield,OR 97477
.l ` OREGON 541-726-3753
811-SPR2014-00836
www.springfield-or.gov 1566 16TH ST permitcenter @springfield-or.gov
RECEIPT NO: 2014000840 RECORD NO: 811-SPR2014-00836 DATE:04/17/2014
?DESCRIPTION • T ' ' ACCOUNT CODE/TRANS CODE , 'I:. AMOUNT DUE ,
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
L.PAYMENTTYPE _ -PAYOR CASHIER:CCARPENTER COMMENTS _ _ ;:AMOUNT PAID
Cash GERALD L&MARIE I UPSHAW REV site
TRUST
TOTAL PAID: 93.60
Mechanical Permit Application DEPARTMENT USE ONLY
SPRINGFIELD
n IM S( Y 3
CIT OF SPP RING'F'IE $D OREGO 4 i { Permit no.:
225 Filth Street • Springfield,OR 97477 • P11(541)726-3753 • I AX(541)726 3689Y' ,\C
OREGON Date: 7i7/iy
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
® Residential ❑ Government ❑Commercial Residential Qt Cost Total
Qty.
ea. cost
JOB SITE INFORMATION AND LOCATION First Appliance 7 $80.00 $D)E
Job site address:1546 100 o r4* I l9 ,..51-reet- Fmwnace/burner including ducts and vents
Cily:Sf('1ngf1e(d Staten{, ZIP: 7y 77 Up to look BTU/hr. $18.50 $
J Over I00k BTU/hr. $22.00 S
Reference: /203 2T7( Taxlot.:0,17od
Heaters/stores/vents
DESCRIPTION OF WORK Unit heater $18.50 $
Celle4 ,ioiC Wood/pellet/gas stove/flue / $42.00 S
Repair/alter/add to heating appliance/
refrigeration unit or cooling system/ $80.00 S
PROPERTY OWNER absorption system
Name: pe4e Pa laymen-0 Evaporated cooler $14.50 $
1' Vent fan with one duct/appliance vent $10.00 $
Address: )564, nior4k /(,e Sired-
Hood with exhaust and duct $14.50 $
City: .s.p.ogY c{i(,,�c, et 4{ I State: (ye I ZIP: ,MI 77 Floor furnace including vent , $80.00 S
Phone5gj-01-Me,_ 17So Fax: - Gas piping
E-mail: One to four outlets $7.50 S
This installation is being made on property owned by me or a Additional outlets(each) 1 $4.50 $
member of my immediate family, and is exempt from licensing Air-handling (wits, including ducts
requirements under ORS 701.010. lip in IRON CFM - S12.00 .$
Signature: Over 10,000 CM $22.00 $
CONTRACTOR INSTALLATION Compressor/absorption system/heat pump
Business name: jam. Up to 3 hp/100k !au $18.50
Up to 15 hp/500k BTU $32.00 S
Address: Up to 30 hp/1,000 BTU $47.50 S
City: State: ZIP:
.__.....__......._......_.__-._. Up l0 50 hp/1.7511 BTU $62.50 $ ,
Phone: - - Fax: - - Over 50111)/1.750 BTU $104.50 5
E-mail: Incinerators
Domestic incinerator $22.50 S
CCl3 license no.: Commercial
Print name: Enter total valuation of mechanical system
and installation costs$
Signature: _.._
linter fee based on valuation of mechanical system.etc. $
Miscellaneous fees items Cost Total
ea. cost
Reinspection $80.00 $
Specially requested inspections(per hr.) $80.00 $
Regulated equipment(unclassed) $14.50 $
Each additional inspection: (I) $80.00 $
APPLICANT USE
(A) Enter subtotal of above fees(or enter set
minimum fee of $ 80.00) $
(B) Investigative lee(equal to[AI) $
(C) Enter 12%surcharge(.12 x IA+BI) $ C7
(D)Seismic fee. 1%(.01 x [A]) $ ,/
Q!)Technology Fee(5%of)AI) $ Li--
440-2545-J(4/I2013/COND TOTAL fees and surcharges(A thr0ugin C): S C/��