HomeMy WebLinkAboutPermit Mechanical 2014-09-25SPRINGFIELD--
225 Fifth St
CITY OF SPRINGFIELD
Springfield,OR 97477
< J11F
Phone: 541-726-3753
OREGON
Building / Residential Permit
Inspection Phone: 541-726-3769
Fax: 541-726-3676
PERMIT NO: 811-SPR2014-02085
v .spdngfield-orgov
permitcenterQspringfield-or.gov
PROJECT STATUS: Issued ISSUED: 09/25/2014 EXPIRES: 03/24/2015
STATUS DATE: 09/25/2014 APPLIED: 09/25/2014
SITE ADDRESS: 4448 CAMELLIA ST, Springfield, OR 97478 SCOPE: Mechanical Only
ASSESOR'S PARCEL NO: 1702323404409 TYPE OF STRUCTURE: Residential
PROJECT DESCRIPTION: LP piping for propane genoreator
OWNER: PRATT BART D Phone Number:
ADDRESS: 4448 CAMELLIA ST
SPRINGFIELD OR 97478
CONTRACTOR INFORMATION
Contractor Type Contractor Name Lic Type Lic No Lic Exp Phone
Mechanical Contractor R & D PROPANE INC CCB 160869 07/23/2016 541-746-4621—
INSPECTIONS REQUIRED
Inspections
2020 Underground Gas Underfloor Gas: After line is installed and required testing and capped if not attached
to an appliance.
2255 Gas Pressure Test
2310 Rough Gas Rough Gas: After line is installed and required testing and capped if not attached to
an appliance.
2999 Final Mechanical Final Mechanical: When all mechanical work is complete.
By signature, I slate 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 lheSont of the property, and the approved set of plans will remain on the site at all times during
Signature
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).
—7S
Date
'TfC;E:
';S PERMIT SHALL EXPIRE IF THE WORK
"'01)17ED UNDER THIS PERMIT IS NOT
`. RIGI=D OR IS ABANDONED FOR
"'lI\Y PERIOD.
Springfield Building Permit 9/25/2014 2:40:02PM Page 1 Of 1
SPNINGFIELO - Cl FY 017 SPRINGFIELD
225 Fifth St
TRANSACTION RECEIPT Springfield,OR97477
541-726-3753
811-SPR2014-02085
v v.spdngfield-ocgov 4448 CAMELLIA ST permits nter@spdngfield-ocgov
RECEIPT N0: 2014002131 RECORD NO: 811•SPR2014.02085
DATE: 09/25/2014
DESCRIPTION
ACCOUNT CODEITRANS CODE
AMOUNT DUE "
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 TYPE PgYOR CASHIER: CCARPENTER
COMMENTS
AMOUNT PAID
Credit Card R&D PROPANE
98.44
615214
TOTAL PAID:
98.44
Mechanical Permit Application DEPARTMENT USE ONLY
5P"1N6F1i1
Permit no.:
225 Fifth Street Springfield, OR 97477 ♦ PH(541)726-3753 FAX(54l)726-3689�( / a
4.
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 OF CONST•RUCTIQN
(ii�'Residential _
❑ Government
❑ Commercial
JOB ;SITE INFORMATION AND LOCATION
Job site address: `IIS ` F(0,m,'�/
City: o
State: D<�
I ZIP: i7y7k
Reference:
Taxlot.:
OESCRIPTIQN :OF' WORK
�lP�fiat��� V
il'77y r2 --
?PROPERTY` OWNER
Name: •1 R
/z
Address: t,()Li l a m ( Its'A
City: F
State: tL�V
ZIP:
Phone: 5ti-/
Heaters/stoves/vents
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
Business name: .f i a
Address: OD
City: _
StAte:
ZIP: 77 j/ 5
Phone: i Ll Z
Fax:
E-mail:
CCB license no.: �G t
Print name: /1L Ce
Signatur :
440-2545-J (5/21/2014/COM)
F'EE SCHEDULE"
Residential
Qty,
Cost
;ea.=' I
Totat
cost
First Apnliance
$82.00
Furnace/burner including ducts andnts
ve
U to 100k BTU/hr.
Over 100k BTU/hr.
1
1 $22,00
$
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
$15.00
$
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 I
j 1
$8.00
$
Additional outlets (each) I
1
$5.00
$
Air -handling units including ducts
Up to 10,000 CFM 1 1
$12.00
$
Over 10,000 CFM 1 1
$22.00
$
Com ressor/absor tions stem/heat numD
Up to 3 hp/100k BTU
$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
$
Htcinerators
Domestic incinerator
Corilmercial -
Enter total valuation of mechanical system
and installation costs $
Enter fee based on valuation of mechanical system, etc.
$
Mtsceila�ous fees _tem
Cost
ba'.
otal
,,cost
Reinspection
$82.00
$
Specially requested inspections (pe
$82.00
$
Regulated equipment (unclassed)
$15.00
$
Each additional inspection: (I)
$82.00
$
ApFLICANT LISE
`
(A) Enter subtotal of above fees (or enter set
minimum fee of $ 82.00)
$
Z -
(B) Investigative fee (equal to [A])
$
(C) Enter 12% surcharge (.12 x [A+B])
$
eW
(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): $ ' ,F,F