HomeMy WebLinkAboutPermit Mechanical 2014-6-24 9yavc_ DeAIL kx r be/+-05 alloq
Mechanical Permit Application DEPARTMENT USE ONLY
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, ,Nam? e 'I' �S i!,r, ` 1 ' C.-0 f; .; Permit no.:
225 Fifth Street• Silt nngh In.OR 47477 . M11541)726-3753 • TAX(541)725 3659 I •'�. 0-7(N,! Date: b -7 Y. / t/
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 W Cominercial Residential Qh, Cost "Total
ca, cost
JOB SITE INFORMATION AND LOCATION First Appliance _ $79.00 S
Job site address: LJL �,/ Furnace/hurner Including duels and vents
It '92 'V�" � Up to IOOk BTU/hr. $17.00 S
City: S�I/1[�:��"t�ld State: R. ZIP:��I-l-`�g
/UVf
Over 1l oo BTU/hr. $20.00 S
Subdivision: Lot no.:
I leaters/stoves/rents
DESCRIPTION OF WORK Unit heater $17.00 S
1 • '.- Q.��
(, t� , ' P � rY t{ Wood/pellet/gas stove/flue $38.00 S
(�-�--- /�; (,�'�� .6 7�00r--- Repair/alter/add to heating appliance/
1.7, �`�� t kJ �VI� p C`r' "-* refrigeration unit or cooling system/ $58.00 S
PROPERTY OWNER absorption system
Name:S49/fit , r I ♦ On 44 4 Evaporated cooler $13.00 S
Vent fan with one duct/appliance vent $9.00 S
Address:
City: 1 T FU r . •te: 'iv"!
Hood with exhaust and duct $13.00 S
Floor furnace including vent $58.00 S
Phone:%fl--3{,-2'j(, I Fax: 9-fl '%-� 1 Gas piping
E-mail: , One to four outlets $7.00 S
This installation is being made on property owned by me or a Additional outlets(each) i $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 571.00 5
Signature: Ytiil/Q COldykr/fr Over 10,000 CFM $20.00 S
CONTRACTOR INSTALLATION Compressor/absorption system/heat pump
Up Business name: �mg)(2: Anti 1\)61 Up to B
15 hp/500k BTU $29.00 S
Address:Il i) t 7 ` SU 1 � Up to 30 hp/1,000 BTU S43.00 5
City:S (LINb'i EL17 )State: ZIP:t74_77 Up to 50 hp/1,750 BTU $57.00 S
Phone: 724-010-'0 � �//I //Fax: -else?-q99- Over 50 hp/1,750 BTU 595.00 5
E-mail: YllelaitgeowtIDY't-ciOInW. 00w Incinerators 1
U Domestic incinerator $20.00 S
CCB license no.: 4/6 Commercial
Print name: MEtfY-` Enter loud valuation of mechanical system
1 (i
and installation e onsv valuation Ii/ J�0
Signature: .k-,(,"]I�fy^'^'A-, Enter fee based on valuation of mechanical system.etc. $
Miscellaneous fees Items Cost Total
ea. cost
Reinspection 558.00 $
Specially requested inspections(per hr.) $58.00 $
Regulated equipment(unclassed) 513.00 5
S � , Each additional inspection:(1) $58.00 S
Q L \� APPLICANT USE
(A)Enter subtotal of above fees(or enter set tr 2 1
0 1 j minimum fee of S 79.00) S o
(B)Investigative fee(equal to[A])
s q I
(C)Enter 12%surcharge(.12 x [A+B]) S Z Y
(D)Seismic fec. l%(.01 x[A]) S 100
(E)Technology Fec(5%of[A]) S
440.2545-i II 1N8/FOM) TOTAL fees and surcharges (A through E): S L
Z C(L
SPRINGFIELD - 225 Fifth St
V t CITY OF SPRINGFIELD Springfield,OR 97477
"� at; Phone: 541-726-3753
Building / Commercial Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2014-01358
www.springfieldor.gov permitcenter @springfield-or.gov
PROJECT STATUS: Issued ISSUED: 06/27/2014 EXPIRES: 12/23/2014
STATUS DATE: 06/27/2014 APPLIED: 06/24/2014
SITE ADDRESS: 4992 MAIN ST,Springfield,OR 97478 SCOPE: Heating System
ASSESOR'S PARCEL NO: 1702333204000 TYPE OF STRUCTURE: Commercial
PROJECT DESCRIPTION: Like for like push pull replacement of Carrier RTU,re-use[E]equip stand-emailed app
OWNER: SQUARE DEAL LUMBER CO INC Phone Number:
ADDRESS: PO BOX 49
SPRINGFIELD OR 97477
L CONTRACTOR INFORMATION
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
Mechanical Contractor COMFORT FLOW HEATING CO COB 460 06/27/2015 541-726-0100
L 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 1:53:56PM Page 1 of 1
SPRINGFIELD CITY OF SPRINGFIELD
`OR O
TRANSACTION RECEIPT Spring eld,OR 97477•
OREGON 541-726-3753
811-SPR2014-01358
www.springfield-or.gov 4992 MAIN ST permitcenter@spdngfield-or.gav
RECEIPT NO: 2014001397 RECORD NO:811-SPR2014.01358 DATE:06/27/2014-77 DESCRIPTION 7777r - ACCOUNT CODE/TRANS_.. ODE AMOUNT DUE .
Continuing Education Fee 224-00000-425606 2.50
Mechanical Permit fee(based on value of work) 224-00000-425604 1006 208.24
State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 24.99
Technology fee(5%of permit total) 100-00000-425605 2099 10.41
TOTAL DUE: 246.14
[ PAYMENT TYPE . .'.PAYOR CASHIER: .',. COMMENTS! =,:;-_,r'5. °: AMOUNT;PAID?_ - . . t1
Credit Card COMFORT FLOW HEATING CO 246.14
09254J
TOTAL PAID: 246.14