HomeMy WebLinkAboutPermit Mechanical 2014-09-05SPRINGFIELD 225 Fifth St
CITY OF SPRINGFIELD Springfield,OR97477
Phone: 541-726-3753
OREGON Building / Residential Permit Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2014-01913
www.spdngfieldor.gov permitcenter@spdngfield-or.gov
PROJECT STATUS: Issued ISSUED: 09/05/2014 EXPIRES: 03/03/2015
STATUS DATE: 09/05/2014 APPLIED: 09/05/2014
SITE ADDRESS: 1527 16TH ST, Springfield, OR 97477 SCOPE: Wood Stove / Insert
ASSESOR'S PARCEL NO: 1703253102600
PROJECT-DESCRIPTION:—New woodstov
OWNER: QUICK BRENT T
ADDRESS: 152716TH ST
TYPE OF STRUCTURE: Residential
Phone Number:
SPRINGFIELD OR 97477
CONTRACTOR INFORMATION
Contractor Type Contractor Name Lic Type Lie No Lic Exp Phone
Mechanical Contractor OWNER ccs 000000 OB/01/2025
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 Safely. 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.
�L�w ,S l�
Owner or Contractor Signature Date
jl !IS PERMIT SHALL EXPIRE IF THE WORK
AIJTHORITED UNDER THIS PERMIT IS NOT
('W.flvlENCED OR IS ABANDONED FOR
ANY 180 DAY PERIOD.
" I I: Cr"la1 Inw requires you to
x ol,led by the Oregon Utility
/n (c ntt,r. `(hose rules are set forth
u, t �It i)52 001-0010 through OAR 952-001-
0090. You may obtain copies of the rules by
callii g the center. (Note: the telephone
numbelfor eeNotification
is 1-600-332-2344)
Centel
Springfield Building Permft 9/5/2014 2:24:29PM Page 1 of 1
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CITY OF SPRINGPIHLD
LSPRINGIFIELD
TRANSACTION RECEIPT
225 Fifth St
Spnngfield,OR 97477
OREGON
811 -SP R2014-01913
541-726-3753
www.spdngfieldor.gov
1527 16TH ST
permitmnter@spdngfield-orgov
RECEIPT NO: 2014001938
RECORD NO: 811-SPR2014.01913
DATE: 09/05/2014
c)
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
Check QUICK BRENT T
98,44
1786
TOTAL PAID: 98.44
Mechanical Permit Application DEPARTMENT USE ONLY
;PRIN GFIELD
I Ilk" I I I1 0 0 Permit no.:
225 Fifth Street ♦ Springfield, OR 97477 + PH(541)726-3753 FAX(541)726-3689 Date: 21S�Itl
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.
Y CONSTRUCTION
CATEGORY
5d Residential
El Government
❑ Commercial
JOB SITE INFORMATION AND LOCATION
Job site address: I(VaAl- 5k
City: j
State:
zip:
Reference: Taxlot.:
OESCRIPTION-OF WORK
Up to I 00k BTU/hr.
$19.001
_,,popP '6WNER
R ty-
Name:
Address: \,54'1
City: 5 tg
State: C�
ZIP:
Phone: ,rtif, 72BkSr7e)o
Fax:
E-mail: ,V6C Qt,.EtLP
This installation is being made on property owned by me or a
member of my immediate family, and is exempt from licensing
requirements under ORS 701.010.
Signature:
GONTRACTOR;J!4STALLATIQN
Business name:
Address:
City:
Stat(
$82.00
Phone:
Fax:
E-mail:
CCB license no.:
Print name:
F Signature:
440 -2545-J (5/2112014/COM)
"FEE 8CHEDULE-
Aiesidentialty
Cost
l �Total.l., �cos-C
First Appliance /1
$82.00
Furnace/burner including ducts and vents
Up to I 00k BTU/hr.
$19.001
$
Over 100k BTU/hr.
$22.001
$
Heaters Lstoves/ vents
Unit heater
$19.00
$
Wood/pellet/gas stove/flue
$43.00
$
Repair/alter/add to heating appliance/
refrigeration unit or cooling system/
absomtion system
$82.00
$
Evaporated cooler
$16.00
$
Vent fan with one ductlappliance
$10.00
$
Hood with exhaust and duct
$16.00
$
Floor furnace including vent
$82.00
1 $
Gas piping
One to four outlets
-Additional outlets (each)
I 1
$6.001
$
Air -handling units, including ducts
Up to 10,000 CFM 1 1
$12.001
$
Over 10,000 CFM 1 1
$22.001
$
Compressor/absorption s stem/heat DUITIA)
Up to 3 hp/100k BTU 1
$19.001
$
Up to 15 bp/500k BTU
$33.00
$
Up to 30 hp/1,000 BTU
$49.00
$
Up to 50 hp/1,750 BTU
$64.001
$
Over 50 hp/1,750 BTU
$107.00
Incinerators
Domestic incinerator
$22.60
$
Comme
Enter total valuation of mechanical system
and installation costs $
Enter fee based on valuation of mechanical system, etc.
$
Misceilaiietius foesMein
cost
6. �'
johil"
cast
Reinspection
$82.00
$
Specially requested inspections (pe i
$02.00
$
Regulated equipment (unclassed)
$15.00
$
Each additional inspection: (1)
$82.00
$
4 ' APDL ICANT-_'I SE -,:",-
(A) Enter subtotal of above fees (or enter set
minimum fee of $ ALOO)
$
(B) Investigative fee (equal to [A])
$
(C) Enter 12% surcharge (.12 x [A+B])
$
(D) Seismic fee, 1%(.01 x [A])
$
(E) Technology Fee (5% of [A])
$
(F) Continuing Education Fee $2.50
$2.50
TOTAL fees and surcharges (A through F)-