HomeMy WebLinkAboutPermit Mechanical 2014-6-25 (2) Mechanical Permit Application ,DEPARTMENT USE ONLYx
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�c cY OF SPRINGFIEL`D,`QREGOMt 1- s., Permit no.. S/Y '
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225 Fifth Street• Springfield,OR 97477 • PH(541)726-3753 • FAX(541)726 3689 q +!L Date: G/2.-)7(4-(
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.
s ° t ;CATEGORY„OF„ CONSTRUCTION % ??„ t> .* .,'FEE SCHEDULE :,ci.2'," , , r „,:
❑Residential El Government 0 Commercial Resident ial _ x k z - Qty.'''', st °do§atl a_
.�' '�, JOB;SITE:i'INFORMATION ANDLOCATION,a;; k ,zr
First Appliance $82.00 $
in- Furnace/burner including ducts and vents
Job site address: . f>='i
-Up to 100k BTU/hr. $19.00 $
City: , Pc 1--0 State: 6 ZIP: ,"7 it 7? Over 100k BTU/hr. $22.00 $
Reference: Taxlot.: Heaters/stoves/vents
;k,- „ ` IDESCRIPTION,'OF WORK; ,..x *". . ;> Unit heater $19.00 $
Wood/pellet/gas stove/flue $43.00 $
Wire- ,4t-Y S & /C �f/DUD Repair/alter/add to heating appliance/
refrigeration unit or cooling system/ . $82.00 $
absorption system
:l...1 .h r. PROPERTY;OWNER `. ".7, ' Evaporated cooler $15.00 $
/fe"y/3L �Z/) ( /2.1 - Vent fan with one duct/appliance $10.00 $
Name: �L nor r Hood with exhaust and duct $15.00 $
Address: f 'zc a(6,01-
1'6 F Floor furnace including vent $82.00 $
City: &Ii. (.7 I State: art- ZIP:77L{41 Z- Gas piping
Phone: - - Fax: - - One to four outlets $8.00 $
Additional outlets(each) $5.00 $
E-mail: Air-handling units,including ducts
This installation is being made on property owned by me or a Up to 10,000 CFM .$12.00 $
member of my immediate family, and is exempt from licensing Over 10,000 CFM $22.00 $
requirements under ORS 701.010. Compressor/absorption system/heat pump
Signature: Up to 3 hp/100k BTU $19.00 $
'>F`" '' k- CONTRACTORJINSTALLATION° E;.' 4 'ei' Up to 15 hp/500k BTU $33.00 $
Up to 30 hp/1,000 BTU $49.00 $
Business name: Corti "T-LOr-c._, Up to 50 hp/1,750 BTU $64.00 $
Address: J g„S7 T7>&... ST , Over 50 hp/1,750 BTU $107.00 $
City:trztvc f)er--,3 State: cZ ZIP: ?? 7 -. Incinerators
Domestic incinerator $22.50 $
Phone] O/e2O Fax:sr- fl ` fcy Gommerclalo . ._, .0 r ,,-5 . `^ ? *c
1E-mail:. - 0.-r'e aeeelM rKrq1-e.. -d,O`4
Enter total valuation of mechanical system
CCB license no.:- 111(00 and installation costs$ 0900
Enter fee based on valuation of mechanical system,etc. $
Print name:\37y7z:ez CCFe a �r •Cost ,Total,'
,Mlsakin'`eous fees,I V- , Items -aea 7cbst3Y
Signatu ` . _ Reinspection $82.00 $
Specially requested inspections (per $82.00 $
Regulated equipment(unclassed) $15.00 $
Each additional inspection:(1) $82.00 $
:''."7`11STZW241A.PMP PLICANTaiUSE' , t.`q*"-t. ; ''"
(A)Enter subtotal of above fees(or enter set + cc Cd-I
minimum fee of $82.00) ${
(B)Investigative fee(equal to[A]) $ r,r'
(C)Enter 12%surcharge(.12 x[A+B]) $ R
(D)Seismic fee, 1%(.01 x[A]) $ c _
(E)Technology Fee(5%of[A]) $ 7=._
(F)Continuing Education Fee$2.50 $2.50
TOTAL fees and surcharges(A through F): V bt(Gv
440-2545-1(5/212014/COM)
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SPRINGFIELD - CITY OF SPRINGFIELD
a�•1 ^• '"° 225 Fifth St
`�o EGO,„ TRANSACTION RECEIPT Springfield•OR97477
541-726-3753
811-SPR2014-01361
www.springfield-or.gov 115 S 5TH ST permitcenter @springfield-or.gov
RECEIPT NO: 2014001367 RECORD NO:811-SPR2014-01361 DATE:06/25/2014
[DESCRIPTION ACCOUNT CODE/TRANS CODE. AMOUNT DUE •
Continuing Education Fee 224-00000-425606 - 2.50
Mechanical Permit fee(based on value of work) 224-00000-425604 1006 82.00
State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 9.84
Technology fee(5%of permit total) 100-00000-425605 2099 4.10
TOTAL DUE: 98.44
LIPAYMENT TYPE :PAYOR CASHIER:CCARPENTER COMMENTS AMOUNT PAID.. � ' : � .I
Check MEZZA LUNA PIZZA 98.44
1011
Check MEZZA LUNA PIZZA 184.60
1011
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TOTAL PAID: 283.04
SPRINGFIELD.__... 225 Fifth St
it{ CITY OF SPRINGFIELD Springfield,OR 97477
`< Phone: 541-726-3753
OREGON Building I Commercial Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2014-01360
www.springfield-or.gov permitcenter@springfield-or.gov .
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PROJECT STATUS: Issued . ISSUED: 06/25/2014 EXPIRES: 12/21/2014
STATUS DATE: - 06/25/2014 APPLIED: 06/25/2014
SITE ADDRESS: 115 S 5TH ST,Springfield,OR 97477 SCOPE: Mechanical Only
ASSESOR'S PARCEL NO: 1703353110400 TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: M-HVAC and Type II Exhaust-Tenant improvement for Mezza Luna Pizza
OWNER: ROYAL BUILDING LTD PARTNERSHIP Phone Number:
. ADDRESS: PO BOX 24608
EUGENE OR 97402
CONTRACTOR INFORMATION
-
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
COMFORT FLOW HEATING CO CCB 460 06/27/2015 541-726-0100
L INSPECTIONS REQUIRED
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Inspections
• 2300 Rough Mechanical Rough Mechanical: Prior to Cover
2530 Kitchen Exhaust/Commercial
Hood
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 ServicesiDivision, 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
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Springfield Building Permit 6/25/2014 9:18:20AM Page 1 of 1