HomeMy WebLinkAboutPermit Mechanical 2014-07-28 (2)[01111 WK01 SUN 10 M =1 1:14
Building / Commercial Permit
PERMIT NO: 811-SPR2014-01558
v .springfieldncgov
225 Fifth St
Springfieid,OR 97477
Phone: 541-726-3753
Inspection Phone: 541-726-3769
Fax: 541-726-3676
permitcenter@spnngfield-ocgov
PROJECT STATUS: Issued ISSUED: 07/28/2014 EXPIRES: 01/23/2015
STATUS DATE: 07/28/2014 APPLIED: 07/21/2014
SITE ADDRESS: 3333 RIVERBEND DR, Springfield, OR 97477
ASSESOR'S PARCEL NO: 1703220004102
-------PROJECT-DESCRIPTION:---
OWNER:
ESCRIPTION: —
OWNER: PEACEHEALTH
ADDRESS: 1115 SE 164TH AVE
SCOPE: Heating System
TYPE OF STRUCTURE: Commercial
Phone Number:
VANCOUVER WA 98683
CONTRACTOR INFORMATION
Contractor Type Contractor Name Lie Type Lie No Lie Exp Phone
General Contractor GREENBERRY CONSTRUCTION LLC CCB 166612 - 09/26/2015 541-752-0381
Mechanical Contractor TWIN RIVERS PLUMBING INC CCB 17695 03111/2015 541-688-1444
INSPECTIONS REQUIRED
Inspections
2300 Rough Mechanical Rough Mechanical: Prior to Cover
2999 Final Mechanical Final Mechanical: When all mechanical work is complete.
2420 Hydronic Piping
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 a property, and the approved set of plans will remain on the site at all limes during
construction.
1j
Owner or Contrac or Signature Date
NOTICE:
THIS PERMITS HALL EXPIRE IF THE WORK
AUTHORIZED UNDER THIS PERMIT IS NO]
COMMENCED OR IS ABANDONED FOR
ANY 180 DAY PERIOD,
ATTENTION: Oregon law requires you to
follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth
In OAR 952-001.0010 through OAR 952.001-
0090. You may obtain copies of the rules by
calling the center. (Note: the telephone
number for the Oregon Utility Notification
Center is 1.800.332-2344).
Springfield Building Permit 7/28/2014 3:13:01PM Page 1 of 1
SPRINGFIELD --
CITY OF SPRINGFIELD
TRANSACTION RECEIPT
225 Fifth St
Spdngfie1d.0R 97477
oaeaoN
811-SPR2014-01558
541-7263753
v m.spdngfieldacgov
3333 RIVERBEND DR
permitcenter@spdngfield-or.gov
RECEIPT NO: 2014001620
RECORD NO: 811-SPR2014.01558
DATE: 07/28/2014
Continuing Education Fee
224-00000-425606
2.50
Mechanical Permit fee (based on value
of work) 224-00000-425604
1006
250.35
Special Occupancy Fee
224-00000-425602
1097
2.50
State of Oregon Surcharge (12% of applicable
fees) 821-00000-215004
1099
30.04
Technology fee (5% of permit total)
100-00000-425605
2099
12.52
TOTAL DUE:
297.91
Check GREENBERRY CONSTRUCTION LLC
297.91
22711
TOTAL PAID: 297.91
CATEGORY OF CONSTRUCTION
E) Residential
I ❑ Government
® Commercial
JOB SITE INFORMATION AND LOCATION
Job site address: 3333 Riverbend Way
City: Springfield
I State: OR
ZIP: 97477
Reference: Selmens 1.6 T MRI
Taxlot:
_
DESCRIPTION OF WORK
Hydronlc piping
PROPERTY OWNER
Name: Sacred Heart Medical Center at Riverbend
Address: 3333 Riverbend Dr
City: Springfleld
State: OR
ZIP: 97477
Phone: 641 -337 -8532-
1 $
E -mail:
This installation is being made on property owned by me or a
member of my immediate family, and is exempt fiont licensing
requirements under ORS 701.010.
Signature:
CONTRACTOR INSTALLATION
Business name: Twin Rivers Plumbing
Address: 1626 Irving Rd.
City: Eugene
State: OR
ZIP: 97404
Phone: 641-6E
Fax: 641-688-9272
E-mail: Gerry@twinrp.com
CCB license no.: 17695
Print name: Gerald S. Bush
Signature:
440-2545-J (5/2112014/CO3M)
FEE SCHEDULE
Residential
Qty,
cost
ca.
'total
cost
First Appliance
1
1 $82.00
Furnace/burner including ducts and vents
Up to 100k BTU/hr.
$19.00
$
Over I 00 BTU/hr.
$22.00
1 $
Heaters/stoves/vents
Unit heater
$19.00
$
Wood/pellet/gas stove/flue
$43.00
$
Repair/alter/add to heating appliance/
refrigeration unit or cooling system/
absorption sstem
$82.00
$
Evaporated cooler
$15.00
$
Vent fan with one duct/appliance
$10.00
$
flood with exhaust and duct
$16.00
$
Floor furnace including vent
$82.00
$
Gas piping
One to four outlets
I 1
$8.001
$
Additional outlets (each)
$5.001
$
Air -handling units including duets
Up to 10,000 CFM
$12.00
$
Over 10,000 CFM
I
$22.00
$
Corn ressor/absor tions stent/heat unn
Up to 3 hp/100k BTU I
$19.00
$
Up to 15 hp/500k BTU
$33.00
$
Up to 30 hp/1,000 BTU
$49.00
$
Up to 50 hp/1,750 BTU
$64.00
$
Over 50 hp/1,750 BTU
$107.00
$
Incinerators
Domestic incinerator
$22.60
$
Commercial
Enter total valuation of mechanical system
and installation costs $ 17,428.00
Enter fee based on valuation of mechanical system, etc.
$ ZSO
Miscellaneous fees ftenisl
cost
ea.
Total
cost
Reinspection
$82.00
$
Specially requested inspections (pe
$82.00
$
Regulated equipment (unclassed)
$15.00
$
Each additional inspection: (1)
APPLICANT `USE
(A) Enter subtotal of above fees (or enter set
minimum fee of $ 82.00)
$
U
(B) Investigative fee (equal to [A])
$
(C) Enter 12% surcharge (.12 x [A+B])
$
122,
(D) Seismic fee, 1%(.O1 x [A])
$
✓
(E) Technology Fee (5% of [A])
$
5
(F) Continuing Education Fee $2,50
$2.50
TOTAL fees and surcharges (A through
F): $
1