HomeMy WebLinkAboutPermit Mechanical 2014-6-24 ceicio bate tau [/ LPs
Mechanical Permit Application DEPARTMENT USE ONLY
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?25Filth SU Ca Springfield,plt 47457• PIIIs4117aM1-?753• FAX(541)726-36S9 .. t. Date:
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 To
❑Residential ❑Government 'Commercial Residential QT east costl
JOB SITE INFORMATION AND LOCATION First Appliance $79.00 S
Job site address:1^(/, - Furnace/burner including ducts and vents
Up to I U0k BTU/hr. 517.00 5
City: Sly) -�``1 State: ZIP:���
( Over 100k BTU/In. 520.00 S
Subdivision: Lot no.:
Heaters/stoves/vents
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DESCRIPTION OF WORK �' Unit heater 517.00 $
i? kt�:_0�^(�� 1�f/J,ylCL dot (SS Sl41 4 — Wood/pellet/gasstove/flue 538.00 S
tV 1� 'tl/'`K�J'� U Repair/alter/add to heating appliance/
refrigeration unit or cooling system/ 558.00 5
n PROPERTY OWNER absorption system
Name: S � ('YP� DOlaA� Evaporated cooler 513.00 $
r �J, I�rj Vent fan with one duct/appliance vent $9.00 S
Address: h(� Ct-JJ
Hood with exhaust and duct 513.00 S
City': '�(� (i State:OL ZIP:9��S Fluor furnace including rent 558.00 5
PhoneSS-5 uo Fax: - - Gas piping
E-mail: One to four outlets 57.00 S
This installation is being made on property owned by ore or a Additional outlets(each) $4.00 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 $11.00 $
Signature: k•• W CO Over 10,001)CFM 520.00 S
CONTRACTOR INSTALLATION Compressor/absorption system/heat pump
Business name: NYv(,rJ'�W Mtn.
1 . Up to 3 hp/100k BTU S17.00 S
Q� ���. � Up to 15 hp/500k BTU 529.00 S
Address:I "tL(�Lg.8 1 I Up to 30 hp/I,000 BTU 543.00 5
City:S RINbEL7 State: Q2 ZIP:TN-77 upto 50hp/1,750 BTU $57.00 S
Phone:44I-72,k—p 1CO, I Fax:t5211-qge—T39/- Over 50 hp/I,750 BTU $95.00 $
E-mail: 111641.1�` _04, OtiV[J Incinerators
Domestic incinerator $20.00 I S
CCB license no.: L+-&U Commercial
EU
Print name: MS,m No Enter total valuation of in cchanical system
cij and installation costs 5 t_) I 0
Signature:
Enter fee based on valuation of mechanical system,etc. 5
Miscellaneous fees Hems C Tot
ea ost cost al
Rcinspection $58.00 S
Specially requested inspections(per hr.) S58.00 S
Regulated equipment(unclassed) 513.00 S
Each additional inspection:(I) 558.00 S
O ,t APPLICANT USE _/
/� (Al Enter subtotal of above fees(or enter set S b
�f \ minimum fee of 5 79,00) S 1/1,. . (B)Investigative fcc(equal In[A]) S
(C)Enter 12%surcharge(.12 x[A+B]) $ 13 O
(D)Seismic fee, l%(.01 x[A]) S �6 (J¢
(F)Technology Fee(5%of[A]) S
440-2545-.1 t I I/0S'CONl TOTAL fees and surcharges(A through E): S
Z St
135
SPRINGFIELD 225 Fifth St
CITY OF SPRINGFIELD Springfield,OR97477
(tit Phone: 541-726-3753
OREGON Building / Commercial Permit Inspection Phone:541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2014-01357
www.springfield-or.gov permitcenterQspringfield-or.gov
PROJECT STATUS: Issued ISSUED: 06/27/2014 EXPIRES: 12/23/2014
STATUS DATE: 06/27/2014 • APPLIED: 06/24/2014
SITE ADDRESS: 925 HARLOW RD,Springfield,OR 97477 SCOPE: Heating System
ASSESOR'S PARCEL NO: 1703223300100 TYPE OF STRUCTURE: Commercial
PROJECT DESCRIPTION: Push pull replace ductless system in rm 205-emailed app
OWNER: SELCO COMMUNITY CREDIT UNION Phone Number
ADDRESS: PO BOX 7487
SPRINGFIELD OR 97475
L CONTRACTOR INFORMATION
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
Mechanical Contractor COMFORT FLOW HEATING CO GCB 460 06/27/2015 541-726-0100
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 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.
Owner or Contractor Signature Date
Springfield Building Permit 6/27/2014 1:56:50PM Page 1 of 1
SPRINGFIELD CITY OF SPRINGFIELD
L ,7. ...4.4.11‘3"- 225 Afth St
, `,'N TRANSACTION RECEIPT Sp ngfield,OR 97477
541-726-3753 OREG
811-SPR2014-01357
www.springfieldor.gov 925 HARLOW RD permitcenter @springfield-or.gov
RECEIPT NO: 2014001398 RECORD NO:811-SPR2014-01357 DATE:06/27/2014
rESCRHPTION . ' - ACCOUNT CODElTRANSCODE' AMOUNT DUE''
Continuing Education Fee 224-00000-425606 2.50
Mechanical Permit fee(based on value of work) 224-00000-425604 1006 113.56
State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 13.63
Technology fee(5%of permit total) 100-00000-425605 2099 5.68
TOTAL DUE: 135.37
LPAYMENT_;TYPE A;., PAYOR !.`CASHIER 9SARPENTER 2,. IC,"- COMMENTS,,„; . , r.,,_ .'. AMOUNT PAID. �1
Credit Card COMFORT FLOW HEATING CO 135.37
09254J
TOTAL PAID: 135.37