HomeMy WebLinkAboutPermit Mechanical 2014-09-25www.spdngfieldar.gov
PROJECT STATUS:
STATUS DATE:
Building / Residential Permit
PERMIT NO: 811-SPR2014-02086
225 Fifth St
Springfield,OR 97477
Phone: 541-726-3753
Inspection Phone: 541-726-3769
Fax: 541-726-3676
permitcenter@spdngfield-or.gov
Issued ISSUED: 09/25/2014 EXPIRES: 03/24/2015
09/25/2014 APPLIED: 09/2512014
SITE ADDRESS: 3291 PARTRIDGE WAY, Springfield, OR 97477
ASSESOR'S PARCEL NO: 1703221306000
PROJECT DESCRIPTION: New gas furnace
OWNER: STILLMAN FAMILY TRUST
ADDRESS: 3291 PARTRIDGE WAY
SCOPE: Single Family Residence
TYPE OF STRUCTURE: Residential
Phone Number:
SPRINGFIELD OR 97477
CONTRACTOR INFORMATION
Contractor Type Contractor Name Lie Type Lie No Lie Exp Phone
Mechanical Contractor DEAN M SHULTZ CCB 183169 08/09/2016 541-556-7862
INSPECTIONS REQUIRED
Inspections
2300 Rough Mechanical Rough Mechanical: Prior to Cover
2999 Final Mechanical Final Mechanical: When all mechanical work is complete.
2260 Gas Service Gas Service: After line is installed and line has been connected to a minimum of one
appliance including required testing. Presure test done at this point.
2310 Rough Gas Rough Gas: After line is installed and required testing and capped if not attached to
an appliance.
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 Slate 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 propepf, an4the approved set of plans will remain on the site at all times during
Owner or Contractor
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
file
hone
number foing r the Oreg noUtiHty Noitificat on
Center is 1.800.332-2344),
Springfield Building Permit
a ��3 -44
Date
0TIsjE;
fills PER
AUTHORIZED SNAEREXPIREIfTNE
COf'01ENCEO UNDER r /is PER WORK
9/25,2014 2:55:53PMIN�/ rsp DAYPERIOD DANDON pl f0S NO Page, of
L_RINELD -- C19'1' OF SPRINGFIELD
225 Fifth St
RTRANSACTION RECEIPT Springfield,OR97477
OREGON
541-726-3753
811-SPR2014-02086
w .spdngfield-ocgov 3291 PARTRIDGE WAY permits rater@spdngfield-or.gov
RECEIPT NO: 2014002133 RECORD NO: 811-SPR2014-02086 DATE: 09/25/2014
DESCRIPTION ACCOUNT CODE/TRANS CODE AMOUNT DUE
Continuing Education Fee 224-00000-425606 2.50
First Appliance Fee 224-00000-425604 1006
State of Oregon Surcharge (12% of applicable fees) 821-00000-215004 1099
82.00
9.84
Technology fee (5% of permit total) 100-00000-425605 2099 4.10
TOTAL DUE: 98.44
`PAYMENT TYPE PAYOR CASHIER: RNOLMAN COMMENTS AMOUNT PAID
Cash Dean Schultz
98.44
TOTAL PAID: 98,44
Mechanical Permit Application DEPARTMENT USE ONLY,
2jjj=1 5 Permit no.:
225 Fifth Street# Springfield, OR 97477 + PH(541)726-3753 # FAX(541)726-3689 Date:
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 CONSTRUCT_
A EGO,RY. O�_ IQN
Residential
anent
El Commercial
JOB SITE IN ON AN Q LOCATIOW,
Job site address: Z—_
CitT,yrlelA)
State:
ZIP:
Reference:
TaxIot.: ULQC)C�C
bSkRIPT 19N.,OF WORK
ERTr.:OWNER 7�
Name: lgicc A 9K---)
$19.00
Address: z
City:y E'
State. -'122
I ZIP: f %z 7
$
Fax:
E-mail:
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:
CONTRACTOR ,INSTALLATION
TIPN
Business name:
Address:
City:
Wood/pellet/gas stove/flue
Phone:,
$
E-mail:
CCB license no.:
Print name:
Signature:
IM
440-2545-J (5/21/2014/COM)
777777777F'E
Qty.
eastResidential
.'
Total t,
cost
First ADDliance
$82.00
t
Furnace/burner including ducts and vents
Up to 100k BTU/hr. jj")j
$19.00
$
Over 100k BTWhr.
$22.001
$
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 system
$82.00
$
Evaporated cooler
$16.00
$
Vent fan with one duct/appliance
$10.00
$
Hood with exhaust and duct
$15.00
$
Floor furnace including vent
$82.00
$
Gas piping
One to four outlets
$8.001
$
Additional outlets (each)
$
Air -handling units, including ducts
Up to 10,000 CFM
1
$12.001
$
Over 10,000 CFM
1
$22.00
$
Com nressor/absorntions ystem/ at munt)
Up to 3 hp/100k BTU 1
$19.001
$
Up to 15 hp/500k BTU
$33.00
$
Up to 30 bp/1,000 BTU
$49.00
$
Up to 50 hp/1,750 BTU
$64.001
$
Over 50 hp/1,750 BTU
$107.00 1
$
Incinerators
Domestic incinerator 1
$22.601
$
Enter total valuation of mechanical system
and installation costs $
Enter fee based on valuation of mechanical system, etc.
$
777
?Vthicellan fte,'•
,,pousf6es ' m
COA
TrAtil
Reinspection
$82.00
$
Specially requested inspections (pe i
$82.00
$
Regulated equipment (unclassed)
$16.00
$
Each additional inspection: (1)
$82.00
$
(A) Enter subtotal of above fees (or enter set
minimum fee of $ 82A0
(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): $