HomeMy WebLinkAboutPermit Mechanical 2004-7-16
.
.-
Status: Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
l..l i t Ul' ;,rKll~l>"l.r,LU
Bu_ing/Combination Permit
PERMIT NO: COM2004-00846
ISSUED: 07/16/2004
APPLIED: 07/12/2004
EXPIRES: 01/16/2005
VALUE:
SITE ADDRESS: 3600 FRANKLIN BLVD
ASSESSOR'S PARCEL NO.: 1703343101000
Eugene
TYPE OF WORK: Mechanical Only
TYPE OF USE:
Alteration
Commercial
PROJECT DESCRIPTION: Replace electric HV AC with gas uuits.
Owner: MYRMO & SONS INC
Address: PO BOX 3215 EUGENE OR 97403
Contractor Type
Mechanical
I CONTRACTORINFORMATlON I
Contractor
HARVEY & PRICE CO
Phone
541-746-1621
# of Stories:
Height of Structure
Type of Heat:
wa~er ype:
Ra I)',\?e:
.~~ y~th:
(.~p':~1illled Building:
- ~ -~, /",<,
1 ~...... . ~-.. -- "
J<J>EWLot!I1ENT INFORMATION I
'v~ ,\'?:-'.! ~~ ,0 REQUIRED PARKING
.'>..~ ~ o..~ _\o~ .~~~_
~..... ~<<; ~v Overlay Dist: rt>'" VJ"" \0' ~qtal:
~<i,. #- ~ \::)~ ~ f> ~'\). # Street Trees Rqd: ~ ~<' ",*' ~a\ll'icapped:
~'\~ ~~~ ~<<; ~ ~ f<,~ Paved Drive Rqd: ~..'lJ O,,'lJ ,q0 Q)':lq;~$O~pact:
~ ,'is? ,'>.~~ _''.J<<; ~ 'X % of Lot Coverage: ,'I> '$'0 ~0"'O~ 0".;s o<'~ !:>
'\'" ~..... ~- '\),' o<,;\...;s .:s' ff' ~<::I
~~~ ~~A4~~4
',,:~ . I PUBLIC IMPROVE~t~'1~~.,,~~vo~,'':<>~~~~~<J~~.
,- I ~~ ~,.i'>.<,v ~0 .~ ~
^<v~' ~~p cJ" ~ 53 ~mtll?~,C:l:'l;
~. ~~'o<' !:l~ <::I ...~.. tjp
~ ~o. c.~ b'l; ",,'1>4.. ~nmu!O!}tDrains:
"! .~ ~qj ~,. v U'",_
~o""O'?' 4,0 '$'0 ~'$'\{>
,<' "C>.l~' i>:-<'Q, ..\0 ~'lJ
~" c.~ ~0 v0
_,,f'
,
I Valuation DescriDtion I
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
Front yard Sethack:
Side 1 Sethack:
Side 2 Sethack:
Rearyard Sethack:
Solar Set hacks:
Street Improvements:
Storm Sewer Available:
Special Instruction:
Notes:
Description
Tvpe of Construction
License
77
Expiration Date
10/3112004
BUILDING INFORMATION I
B
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft GaragelCarport
Sq Ft Other:
Occupant Load:
VN
n/a
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Total Value of Project
"___ 1 _~"
.
\...11 r VI' ~rl:Ul'lbI'U..LU
BtpdinglCombination Permit
PERMIT NO: COM2004-00846
ISSUED: 07/16/2004
APPLIED: 07/12/2004
EXPIRES: 01116/2005
VALUE:.
Status:
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
I Fees Paid I
Fee Description
-Mechanical Issuance Fee-
+ 10% Administrative Fee
+ 7% State Surcharge
Furnace - more than 100,000
Gas Outlets 1-4
Minimum/Adjustment Mechanical
Amount Paid
Date Paid
Receipt Number
$10.00
$4.50
$3.15
$30.00
$4.00
$11.00
7/12/04
7/12/04
7/12/04
7/12/04
7/12/04
7/12/04
2200400000000000909
2200400000000000909
2200400000000000909
2200400000000000909
2200400000000000909
2200400000000000909
Total Amount Paid
$62.65
I Plan Reviews I
SUB Review
07/1212004
07/1612004
APP JF
hvac only.
To Request an inspection call the 24 hour recording at 726-3769. All inspection requested before 7:00 a.m.
will be made the same working day, inspections requested after 7:00 a.m. will be made the following work
day.
I Reouil,-ed Tnsnections I
11111.1.
Rough Mechanical: Prior to Cover
Final Mechanical: When all mecbanical work is complete.
Rough Gas: After line is installed and required testing and capped if not attached to an appliance.
Final Gas: When all gas work is complete.
SUB Mechanical: Following City Rough Mechanical inspection approval and prior to any cover.
By'signature, I state and agree, that 1 have carefully examined the completed application and do hereby certify that all
information hereon is true and correct, and 1 further certify that any and all work performed shall be done in accordance with
the Ordinances of the City of Springfield and the Laws of the State of Oregon pertaining to the work described herein, and that
NO OCCUPANCY will be made of any structure without permission of the Community Services Division, Building Safety. I
further certify that only contractors and employees who are in compliance with ORS 701.005 will be used on this project.
I further.agree to ensure that all required inspections are requested at the proper time, that each address is readahle from the
street, that the permit card is located at the front of the property, and the approved set of plans will remain on the site at all
tim uring constljJJCtiofi\ . ~
.1. u r<};-:-<P--.;- t?C-
/ 'jC {/~ t-o_
,_ I ~- o'-/-
~
Owner or Contractors Signature
Date
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HARVEY & PRICE CO.
Fax Transmittal Sheet
CCB #77
Date:
, ~:;~4 d:;'~';:'ro."
r7;L/?_-.<:-n_
~$
Firm:
AUD:
PhoDe: Fax: ?;;...;;; ?jf:'?h
From:~,,/)oI&~ .
Re: ~:_A ~_, , / #~ .-...~ k~~
31060 f'~~<-L.l N / r
Number to call to confirm receipt: 541-746-1621
Sender's fax number: 541-746-8729 or
541-741-7646 for Brian KuhDhenD
Message:
E"-//
~n~ 4?,&';;"'~_ ~<'
- , -
Col\<\ 'Z..OC,\-- 00 <5' ~
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Fo S--C.'S-\'L
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p. o. ~ 1910 ~. o;e 97440 ~,(5411 746-1621 7... (541) 746-U29
"'66@"....'I1Y~.-. <e4 00077
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Form 4b #1'1 OM f)
~ <;;'1$
Project Name:. Page: ( I
COMPLEX HVAC SYSTEMS
1. Simple or Complex System (Sections 1313.2 & 1313.si
Note: This lorm Is required lor complex systems only. If your plans qualify as a slmple system as
defined by the code, you can skip this form,
2. Simultaneous Beating and CoollDg (Section 1313.3.3.11
o No Cooling. The building plans and speciflC8tions can lor a heating-only system,
d' Complies. Temperature and humidity controls are capable 01 operattng In sequence the supply
r of cooling aOO heating energy to the zone as res1uired by the code. Controls for this purpose are
ti detalled In the plans and specifications on: Mlf!:P., ~~r
Exeep. ons 0 Exception. The building or part 01 the building Qualifies for an exception lrom the code. The
Discussion of applicable code exception Is Section 1313.3.3.1, Exception:_ . Portions of the building that
qualifying --P- qualify:
tions on page 4-20,
3. Humidity Controls (Section 1313.3.3.2) . .
;;r No Moisture Added to Building. The building plans do not callier a means to add moisture to
/" malntaln specific humidity levels. .
o Complies. All new humidily control systems are equipped with a humidistat as required by code.
Air
Transport
Energy
See TabiD IH.
page 4-24, (",
maximum horss-
power alJowed.
4 Air Transport Energy (Section 1313.3.4.2 & Table 13.LI
;;l Complies. The energy demand 01 all HVAC Ian systems meets code requirements. Complete
r the form below.
I.J Exception. The applicable code exception is Sec\lon 1313.3.4.2. Exception:_. Porllons at tho.
~ ~~ I ~ .
System Constant Design Motor Allowed Where notad In
10 Oescrtptlon Volume Airflow (elm) HP HP plans/specs
I
t:'t4.1 qPf..fb()/7.. c,/
*",e.
3,'7
t:n~z 4(#-I6()/2- e.'/
I
,
C/oc&-
3,7
building thet qualify:
5. Motor Efficiency (Section 1313.3.5 & Table 13-M)
o Not Regulated. There are no NEMA Dest9n A & B squlll'lll cage. ..frame induCllon. pennanenUy
wired polyphase motolS of ono horsepower or more which seIVe buin-up HVAC systems (regu.
ri latall motors).
);, Complies. The efficiency of ell regulated motors meets code requirements.
Exceptions 0 Exception. The applicable code exception is Section 1313,3.4.2. Exception:_ . Portions at the
buUdlng that qualify:
DiswssIon or
quaBIyIng -
tionsMpDg.4-22. J Variable Speed Drives (Section 1313.3.5.1)
Not Regulated. The building plans and speclfica~ons do not call lor tan and pump motors 25
horsepower and greater that serve varlable.flow air or Uquld systems.
o Complies. All fan and pump motors 2S hp and greater which serve variable-flow air or liquid
systems are controlled by a venable-speed drive.
(10.00)
Forms & Wor1<sheels
p.i:::
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Page: Z.
Fonn 4a (cont.)
SYSTEMS - GENERAL
Project Name:
7. OU-hour Controls - HVAC Systems (Section 1313.1.3.31
Jii COmpiles. An new HVAC systems ere capable of automatic setback or shutdown during periods
of non-use or alternate use of the space served by the system.
o exception. Equipment has fun load heating demands of 2 WI (6,826 Bfulhr) or less and is
control1ed by a reedlly eccessIble manual off-hour control.
8. OU-hour Controls - Supply BDd Exbaust c,J":_--'s 11313.1.3.3)
" COmpiles. Plans require that outdoor eir supply end exhaust systems have a means of auto-
matic (either .,...:_.:~_j orgravity damper) lI01ume shutoff or reduction during periods of non-use
or a1temate use of the space served by the system.
o Exception. The bUilding qualifies for an excepllon fo the requlremenl for automallc: shutoff or
reduction. The appficable code exception Is Section 1313.1.3.3. Exc:eplion _'
~ Heat PaDip Controls ISection 1313.1.3.4)
ya No Heat Pump. The plans/specs do not c:aillor a new heat pump.
o COmplies. AD new heat pumps equipped with suppl_.,,~,,;"1)' heaters are controlled as required
In Section 1313.1.3.4.
~ ',,01
quaIllinp ...,.".
liansonpago4-lB
.
10. Equipment Performance (Section 1313.1.41
o No New HVAC Equipment. The building plans do not call lor new electrical HVAC equipment,
combustion heating equipment or heat-operated cooling equipment.
J4 Compiles. AD new HVAc equipment haS eflIclencles not less then those (BQulre<lllY the code.
The following equipment efficiency worlalheels are attaohed: fb<J...e f .d....A... .
11. Duct Insulation (Section 1313.2.281 1313.3.21
o No Duels. The building plans and specIfi.."JL..~ do nol c:ail1or new HVAC duds or plenums.
o Simple System: Compiles. The plans and ~~~..;;:...;.;;... ~ c:aillor a Simple System. and all
exlerlor supplylretum a1r-handilng ducts end plenums and en outside elr duelS are Insulated as
required by SectIon 1313.2.2.
." Complex System: Complies. The building planslspecs c:aU lor a Complex System, and ell air-
T hanclling duelS and plenums lIIlllnsuleted as required by Sec. 1313.3.2.
1
~. Piping Inm1at101l (Section 13141
~ No New Piping. The buUding plans end specifica\Ions do not cell lor new piping serving a
,heating or cOoling system or part 01 a ctraJlallng service water heating system..
o Compiles. AD new piping servtng a healing or coollng system or part of a ctn:ulating service
water healing system compIlas wiIh the reqt~.... ...:"oltheCode, Sect10n 1314.1.
o Ex...~::.. ~ New piping queJilIes for the loIIowlng ~._~~~"": SectIon 1314, Exception _ .
Exceptions
Exceptions
Dioc< '""'" 01
~-
_on_4-'8
9. Service Water BeatiDg (Section 1315)
14 No New Water Heetlng. The building pIens and specifications do not call lor new waler heaters,
hot water storage tanks, service hot water distribution systems, swimming pools or spas.
o Complies. AD new water healers, hot water storage tanks, serVice hot water dislrlbu1ion sys-
tems, swimming pools or spas comply with the requlremenls 01 the Code.
o exception. The eppIlcabIe code exception Is Seclion , Exception _ . Portions 01
the building that qualify'
4-2
Forms & WOlkBhests
('OIDO)
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Worksheet 4a
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.
project Name:
l;;l"tJJ f"tC-CfC::J
.
p...
Page: .5,
Equipment Cooling Proposed Proposed
Seasonal or Part
0i3cu..... of Equip, Model Designation Capacity Steady Stata Load EffICiency Ref.
equipmonI ratings /0 (BtuIh) Efficiency (EER) Une
end equipment (SEER or /PL V)
de_S on pago
4-,g
I ##.16 ~/2- / 2-0 p~o //,()~ ?
z,.. qjH-/6 dl2-- / ~o PI?O /I,t>() ?
Required
Documentll-
tion
Code
Required
Efficiencies
__01
eqvIpnionl oII/CIencles
....18fotm._ from
Ih8cod.. r_13-G
Q..O 1:' r-. O..H
FORMS
OCT 2000
4-4
Indicate source of Information
-----ARI Unitary Directory, Section AC, page:
ARI Applied Products Directory, Section ULE, page:
Product data (Attach data furnIshed by the equipment suppliar. I.a.. "cut sheetsj
I II or e i iea a se ed Dmvided
Equipment Type
Single Packaga
without a
heating section
or witfj electric
resistance heat
Sp/H Systam
withOut a
heatlnl1 section
or wItfj electric
resistance haat
Slngla Package
with 0 heating
section other
than alectric
resistance heat
Sp'/H SYStem
with a fleeting
section other
than electric
resistanca heat
. Condensing Unit
Only
Cooling Capacity (Btulh)
Equal to or B
greater than ut less than
o
65,000
135,000
240,000
760.000
o
65,000
135.000
240,000
760,000
o
65,000
135,000
240,000
760,000
o
65,000
135.000
240,000
760,000
135,000
65,000
135,000
240,000
760,000
55,000
135,000
240,000
760,000
65,000
135.000
240,000
760,000
65,000
135,000
240,000
760,000
Forms & Worlcsheets
Minimum Rallng
Seasonal or
Part Load
9.7 SEER
10.51PLV
9.9IPLV
9.7IPLV
9AIPLV
10.0 SEER
10,61PLV
9.9IPLV
9.7/PLV
9AIPLV
Steady State
na
10.3 EER
9.7 EER
9.5 EER
9.2 EER
na
10.3 EER
9,7EER
9.5 EER
9.2 EER
na
10.1 EER
9.5 EER
9.3 EER
9.0 EER
ne
10.1 EER
1l.5EER
9.3 EER
9.0 EER
10.1 EER
Ref.
Uno
(1)
(2)
9.7 SEER
lOA IPLV
9.7IPLV
9.5/PLV
9.2IPLV
10.0 SEER
10A/PLV
9.7IPLV
9.5IPLV
9.2/PLV
11.2/PLV
(3)
(4)
(5)
,I
(10100)
nar-
Uf U"T J.J.;;"TOa
nc:l"-'Vlt!'~ ClInOl
r-rlce l..Omfl'an~
l:)...lJ
ARI* capacity lings
UNIT MOMIIlAL STMIlARD COOUNG
aHJ roNS CFU ~t
. EJRlO4 3 12C1O 38.000
- . '.50 46.000
D/ElFOO6 S 1750 61.000
Il/EIAlO7 . 2"'0 74.000
MIRlO8 7.5 3000 80.000
M;JFl109 6.5 3000 102.000
llIEJFO.2 10 3200 120,000
00" 125 4300 139,000
"'4 125 4300 139.000
LEGENO
8cIs Somd LIN8b(1 bel = 10 dedbeb}
EER Enerw E/fIdenCy ReIio
IPUI - "0 ...... Part.l..OIIlId Value
SEER SeesonaI Enerw E1fidency Rallo
"'_' ...' ';..il. ..ng&r.. '~l ....:... 1nsGtuto.
tAclPIles orIy to inti; _ capodIy 0I6S,OOO IlIlA1 '" leSs.
"ThoIPl.lllsnol~to;.,.. . ...........
NOlel:
I. _In ,.., ....., _ ARI_ 2'0/2010 (004<).2.....) '" 360
(01......).... 270 (004-014 unIIs~
lOTAL
IlW
3.21
4.25
S.SS
..70
8.18
B.44
10.91
14.04
14.04
2.
SOUND RA11NQ
~\
11.20 7.6
11.05 7.6
11.00 8.0
11.00 aD
11.00 8.2 ".6
10.80 8..2 10.9
11.00 8,4 11.4
8.5 ae SI.O
9.5 1.6 9A
Ratings are net......, ..1lB<ting Ihe _ of c:l1allaIIng Ian ...... Rallngs
ant baaod on:
~~.~~lndoorenterfng.elJlempeta!ureand95F
PLY Standard: sO F db" ff1 F wb /Moor lINerinO-air tarnperaSurn and DO F
db_en!orinll-Bir""""""" .
.
SEERt
EER
13.0
,3,0
13.0
.
SIuC 004.012
Only
HEAllNG CAPA",. u:.3 AND EfFIciENCIES
208/230-1-60 - SINGlE STAGE GI\S HEAT
OUTPUT CAMClTY
.
UNIT
4IIKI
BI04
RI04
--
EGOS
RlOS
IlOO6
EOO6
RlO6
IIIl'<Il' """""'"
1"~ _SIne
72.OfKJ
1\5,000
72.OfKJ
116.000
150.000
72.IlClO
115.000
.50.000
1&1 SIa\1O
61)040'
92.000
".040
93,'50
'20.000
59,040
83.150
'20,000
--
'I1!MPERA1VRE
R1SEI"Fl
t5-45
~
,.....
~
-
15-45
~
~
~
208/23tH-60 - SINGlE S1l\GE GAS HEAT - LOW NO.
OUTPUT CAfIlCm'
UNIT
48lIJ
-
-
l.nos
-
--
LOO6
-
.....
INPUT CAFIlCITY
'''~ _Sloae
60.000
Blum
60,000
80:000
.20..000
60.000
90.000
'20..000
.&1_
.s.ciioi
72.000
48.ClOO
~ooo
9B.OOO
Q,iiiiO
12JlOO
lIIl.OOO
2nd __
1EIIPERAlURE
RlSEI"Fl
.......
-
.......
30<00
40-70
2l).5O
3HO
40-70
.
UNIT
......
-
NOll4
. LIIll!l
-
NII05
.....
IlOO6
.....
INPUT CAAlClTY
208/230/460-3-60 - SINGlE S'mGE GAS HEAT - LOW NOx
....-
OIITPIIT CAPACITY
1"_
60.000
90.000
00.0lIO
90.000
'20,000
60.0lIO
90.000
120.f'?9
1..!'!!l!"
....000
7?JlOIl
.a'iJOO
72.OOCl
98(100
....000
72.000
~
--
TEIIPEIIA1URE
RISE("FJ
.....,
-
a\.!;o
3Q.6O
.0-70
2l).5O
:'IH;Q
~~
l"'b-tlli::'::J
p.:>
~
IPLV
e
S- 014 Only
EFf'CIENCY
AFUEll"1 _Slatell"'
82'l' 82
IlO'll. eo
.... 82
81% 81
_ so
..... 82
81% 81
80... eo
EFf1CIENCY
AFUEll"1 -. Slate ""I
._ eo
eo-.. eo
80% IKl
80% eo
80% eo
eo-.. 80
eo... 80
eo-.. eo
EmCIEHCY
ARlEI""
""'"
"'1'"'
'"'"
IlO'll.
110%
8<'%
eo-..
~
__C,.I
'eo
IKl
eo
eo
eo
80
80
80
117
UP OfficeJet . .
Fax Log Report
Personal Printer/Fax/Copier
Jul-12-04 01:46 PM
ll!Im!ificatiog R!mll! ll!&!l! Ixm DlW; Iiml; ,Duratioll Dismostic
97443654 OK 05 Sent Jo1-12 01:43P 00:03:23 002586030022
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225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689
b"Z..\<O>
City Job NumberCO~ '2.OD4- ~'DO~ Date 0 l - \ L -06,-
o I & 2 Family Dwelling or Accessory 0 New Construction
o Multi-Family ~ AdditionlAlteration/Replacement
~ CommerciallIndustrial 0 Tenant Improvement
Job Address S ~<!>O PKlItN !CU~N BLvd.,
Lot Block Subdivision
Project Name M.~If""'o ~ SON!
Description ofWorkllocatior: on premises/special conditions RejJlftCE:. (,:{) VN iTS ~ r::.<lV i"N(j. {J Fi=/oce A.<eC';"
B P~opertyOumer
Name M'iI)~O 't ,rON~
Mailing Address iJ. (J - f3 /!) 1<- "3;J. I 5
City t::.U 6-SI/,; State Ol(!. Zip '7 7 ~ 3
Phone 7 ft7- 'T~'5 Fax
~.., 0 U'V
Owner Representative '-'< (C ,,, v.lt /I{ 0
Phone 7 '1-7 - 'I S"' !: Fax
.
!J'C....r"~:>"",. "';'"l. '_ -.)." ..c....''':.~''''_.T~.j<;?~.''~ft.."1'< ..,.,:,::r.;r>l.A....'~~":'--.;',;.,,'""'-.~ ~
O \~p!,I'f~li~::iift)N:-.~t-~&~~':;f~~!A1~~~~;1::;;;~,~._.~;:~f~.rf~~if~~~~'0:.;J~
"... ..,. .....' ."'. ...,,-,....,-'Y:/-'-'i>"'" "?,:.',...."..r.'
Name /m1!Vo/ ~ fo/~'CC '-<).
Mailing Address tP_c)~ 130,1( ,1. Co
City E:v H-.9I/' ~ State O/t. Zip '77 'i'fO
Phone 7l'lD -{(j,~1 Fax 7~' - e-7~'1
, . " "
o .' A~ehite~t/D~signej./Engin~e~
Name
Address
. "',J".
State
Zip
City
Contact Person
Phone Fax
o fr9.~I,i~.;.<<a,~.n:(,9}H.: . .... '.'
Contractor's Name
.'
., "-'.,.,,;,,(
...:: '.
J
General
Plumbing
Mechanical
Electrical
o " :C'!.~me;;cialllnclUstriClI Projects
Has site review application been submitted?
DYes 0 No 0 N/A
If so, Name of Planner
Journal Number
SA,"'" voAAI E
1i/f1f.1I~ q/. ~-kt(cr ~/)If(\J'(
0.5
o
o
Demolition
Other
Bldg No. Suite No,
Tax Maprrax Lot 1'( 0 ~ ~4-3 \ 0 lOeo
1 & 2 Family Dwelling
SQFt
x $/SQ Ft
Value
New Dwelling Area
Garage/Carport Area
Other Structure Area
Total Value
f:ki<~'t.,.i":'::,~~';".>>~..,?":.''''''''"~,-;;''",,,,,,'',,':~ " .-' . "<l'~' ,
,siJi/tnih'ct'i:i~lliridiJiHal/llfulti:F.izfuiiiJ';;~1.' :,::i: I, '. ,:,;".,
SQ Ft X $ISQ Ft = Value
Existing Building Area
New Building Area
Total Value
Existing
New
Occupancy Group(s)
Cons!. Tvpe(s)
Number of Stories
, "',.".
Expiration Date
Phone #
CCB#
77
w-:n-oy.
7 'for.. -(&,;,/./
o RcsiclentiClI Projects
Heat Source: Primary
Water Healer Range
Do you require any of the following for this project?
. Over-width or Second Driveway 0 Yes 0 No
Temporary Powcr 0 Yes 0 No
Notice: All contractors & subcontractors are required to be licensed with the Construction Contractors Board of the State of Oregon
under provisions of ORS 70 I and may be reauired to be licensed in the iurisdiction where work is bein::!. oerformed.
I:For Offiee Use Only . J
I PLAN CHECK FEE I I RCPT# I DATE !01-(vOll.-1 BY 1.Jl'A\'"
Secondary
Energy Path
APPLICATION
BUILDING
PERMIT
/-
Shared Drivc(T:)'8uildilll; Fonn...,lIluilding reml;l Application IO.02.dOC'
I . 225 Fifth Street
Springfield, Oregon 97477
;1 541-726-3759 Phone
.
a~._.,.._.,..,.,._,!..,..
~.
.-:
1iiI.Y of Springfield Official Receipt
.elopment Services Department
Public Works Department
RECEIPT #:
2200400000000000909
Date: 07/12/2004
9:17:50AM
Job/Journal Number
COM2004-00846
COM2004-00846
COM2004-00846
COM2004-00846
COM2004-00846
COM2004-00846
Description
+ 7% State Surcharge
+ 10% Administrative Fee
Furnace - more than 100,000
Gas Outlets 1-4
Minimum/Adjustment Mechanical
-Mechanical Issuance Fee-
Payments:
Type of Payment Paid By
Item Total:
l:heck Number Authorization
Received By Batch Number Number How Received
Amount Due
3.15
4.50
30,00
4.00
11.00
10.00
$62.65
Amount Paid
Check
HARVEY & PRlCE
jmp
81217
In Person
Payment Total:
$62,65
$62.65
7112/2004
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