HomeMy WebLinkAboutPermit Mechanical 2014-7-11 SPRINGFIELD • 225 Fifth St
"° - — CITY OF SPRINGFIELD Springfield,OR97477
`' on¢e;oN Phone: 541-726-3753
Building / Residential Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
. PERMIT NO: 811-SPR2014-01503
www.springfield-or.gov permitcenter @springfield-or.gov
PROJECT STATUS: Issued ISSUED: 07/11/2014 EXPIRES: .. 01/06/2015
.
STATUS DATE: 07/11/2014 APPLIED: 07/11/2014
SITE ADDRESS: 2433 11TH ST,Springfield,OR 97477 SCOPE: Wood Stove/Insert
ASSESOR'S PARCEL NO: 1703261104600 TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: Woodstove insert
OWNER: TRUST AGREEMENT DATED FEBRUARY 12 2008 Phone Number:
ADDRESS: 2433 11TH ST
SPRINGFIELD OR 97477
CONTRACTOR INFORMATION
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
Mechanical Contractor ARTHUR MESMAN CCB 191813 09/09/2014 541-337-2028
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 of the property, and the approved set of plans will remain on the site at all times during
construction.
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Owner or Contractor Signature Date
NOTICE: ATTENTION: Oregon law requires you to
foilow 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
ANY 180 DAY PERIOD. calling the center. (Note: the telephone
number for the Oregon Utility Notification
Center is 1-800-332-2344).
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Springfield Building Permit 7/11/2014 1:41:46PM Page 1 of 1
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SPRINGFIELD a CITY OF SPRINGFIELD
225 Fifth St
TRANSACTION RECEIPT Spnngfield,OR97477
� tA 541-726-3753
OREGON 811-SPR2014-01503
www.spnngfield-or.gov 2433 11TH ST permitcenter@springield-or.gov
RECEIPT NO: 2014001502 RECORD NO:811-SPR2014.01503 DATE:07/11/2014
Pail) c t .^^.:..:.,;..c .$r..itti, rAc_,;; 41: `.'ACGOUNT,CODEEIRANSICOD d, . iu aX.:k' .'AMOUNTDUE°
Continuing Education Fee 224-00000-425606 2.50
First Appliance Fee 224-00000-425604 1006 82.00
State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 9.84
Technology fee(5%of permit total) 100-00000-425605 2099 4.10
TOTAL DUE: 98.44
PAYMENT wTYPE P CASHIER CAR EP'r NTER .COMMENTS — AMOUNT,PAID
Check TRUST AGREEMENT DATED FEBRU. 98.44
131 12 2008
TOTAL PAID: 98.44
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Mechanical Permit Application DEPARTMENT USE ONLY
•'9 ry'- y tY"� 5�., lb{.3Wi {fie .{ t"^§,§,i 4 A8 G 5G v 1.s"t i SPRINGFIELD
)4gC1TX70F,SPRINGFIEEDbOREGON ;:t. is , Permit no.: ,/L/- /5-6 3
225 Fifth Street• Springfield,OR 97477 • PH(541)726-3753 • FAX(541)726-3689 ;: :, Date: 7///// 7"
This permit is issued under OAR 918-440-0050. Permits expire if work is not started within 180 days of issuance or if work is
suspended for 180 days.
"f CATEGORY„OF CONSTRUCTION " *' ?�s K. .w? i}l„* ';;FEE'SCHEDULE r', ;,, ,,,
�. } i !.Cost Total
.@$esidential [' Government 0 Commercial yResldential ,� < .` Qty. '; e cast's:'
'`r JOB;_SITEINF'1O1RMATIONANa3LOCATION,-:, ` First Appliance $82.00 $ yZ
Job site address: �`'I 3 3 'ti` S T Furnace/burner including ducts and vents
Up to 100k BTU/hr. _ $19.00 $
City: Si)y. ,-''v ,.t I A State: Q ZIP: q 7 417 Over IOOk BTU/hr. $22.00 $
Reference: 5D Taxlot.: Heaters/stoves/vents
","w „ -`w DESCRIPTION fOF ,WORK, t , t ,;
Unit heater $19.00 $
ood/pellet/gas stove/flue $43.00 $
` n St4GZ w6QCS 401Z1L (/ ..A..u� , Repair/alter/add to heating appliance/
refrigeration unit or cooling system/ $82.00 $
absorption system
7tg: 'Yx s, Wri;VpR,OPERTY°eOWNER j '_Mt r, , ' :<a - Evaporated cooler $15.00 $
Vent fan with one duct/appliance $10.00 $
Name: M R tit K A tO IC iv,t1./
7 Hood with exhaust and duct $15.00 $
Address: .)-y 3 j i[ Imo- I- Floor furnace including vent $82.00 $
City: $'r ir-fA ,•,y ,d State: ZIP: '574.77 Gas piping
Phone:{F ?at, SSal1. Fax: - -
One to four outlets $8.00 $
Additional outlets(each) $5.00 $
E-mail: ry.K P-jt@ C Wr c.c s.} , 1-v,ak 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: 71(1.c.,r IL Annit_v•-ty Up to 3 hp/100k BTU $19.00 $
w b `CONTRAOTORrINSTALEATION c-r`x, " `.$* Up to 15 hp/500k BTU $3100 $
Business name: r,e kac_ce_ ] A r f /11 54(.bvi Up to 50 hp/1,750 BTU $64.00 $
Q Up to 50 hp/1,750 BTU $84.00 $
Address: Over 50 hp/1,750 BTU $107.00 $
City: State: ZIP: Incinerators
S"t - Domestic incinerator $22.50 $
Phone: - - Fax: -
'�CORIRIerOaal ' .,,:K t . .,;ry{It • :4.£`z'-' i ;'.i iz
E-mail: Enter total valuation of mechanical system
and installation costs$
CCB license no.: -
. Enter fee based on valuation of mechanical system,etc. $
Print name: ti . r , :.
iMiscellaneous fees IW 5' hems. Cost r Totatt' ,
`'
Signature: Reinspection _ $82.00 $
Specially requested inspections (per $82.00 $
Regulated equipment(unclassed) $15.00 $
Each additional inspection:(1) $82.00 $
1115:817Mitt..titi4sliP PLICANT USEFhr>.,,.;)M . IN
(A)Enter subtotal of above fees(or enter set
minimum fee of $82.00) $ f .
(B)Investigative fee(equal to[A]) $
(C)Enter 12%surcharge(.12 x[A+B]) $ 92:2
(D)Seismic fee, 1%(.01 x [A]) $
(E)Technology Fee(5%of[A]) $ y/2- ,
(F)Continuing Education Fee$2.50 $2.50��
TOTAL fees and surcharges(A through F): $ �'1_Y
440-2545-1(5/21/2014/COM)