HomeMy WebLinkAboutPermit Mechanical 2019-09-12OREGON
Web Address: www.springfield-or.9ov
Building Permit
Residential Mechanical
Permit Number: 81r-19-OO2l09-MECH
M Number:811057641988
City of Springfield
Development and Public Works
225 Fifth Street
Springfield, OR 97477
541-7 26-37 53
Email Address: germitcenter@sprinqfield-or.9ov
SPRINGfIELD
$
Permit lssued: September 12, 2019
Category of Construction: Single Family Dwelling
Submitted Job Value: $0.00
Description of Work: Ductless Heat Pump
Type of work: New
Worksite Address
1131 1ST ST
Springfield, OR 97477
Parcel
1703263301500
Owner:
Addr€ss:
KEELERCLAIREAS&
MATTHEW P
1131 1ST ST
SPRINGFIELO, OR 97477
Business Name
OWNER - Primary
License Number
000000
Phone
lnspection
2999 Final Mechanical
2300 Rough Mechanical
2100 AC/Furnace/Heat Pump/HVAC
tnspcction Group
Mech Res
Mech Res
Mech Res
Inspection Status
Pending
Pending
Pending
Various inspections are minimally required on each project and often dependent on the scope of work. Contact
the issuing jurisdiction indicated on the permit to determine required inspections for this project.
Schedule or track inspections at wwl^l.buildingpermits.oregon.gov
Call or text the word "schedule" to 1-888-299-2821 use IVR number: 811057641988
Schedule using the Oregon ePermitting lnspection App, search "epermifting" in the app store
permtts expire if work Is not start€d withln 18O Days ot lssuance or lf work is suspended for 18O DaYs or longer d€P€ndhg on
the issulhg agency's policy.
Att proytstons of tawr and ordlnanc€s goyemlng this type of work wlll be complled with whcth€r spcclflcd hercin or not.
Grantlng of a permlt does not pr€sume to glve authorlty to violate or canc€l the Provisions of any oth€r state or local law
regulatlng constructlon or tirc p.rformanca ot consttucdon'
ATTET{TIOfl: Oregon taw requlres you to rollow rules adopted by th. Oregon Udllty ttotiflc.tion Center. Thos€ rules.re set
forth in oaR 952-ool-oo10 through oai 952-oo1-oo9o. You may obtaln copl.'6 of th€ rules by calllng th€ center at (5o3)
232-t9gr.
aI pgsons or enudes p€rformlng y{ork und€r thls pcrmlt are requlrld to be llcen.,€d unless excmptcd bY oRs 701.o10
(structural/iiechanlcal), oRs 479.540 (Electrlc.l), and oRs 6t3.olo-o2o (Plumbing).
ktnted on: 9/12119 pate I of 2 c:\myReports/reports//productiorv0t STANDARD
TYPE OF WORK
JOB SITE II{FORI,IATION
LICENSED PROFESSIONAL INFORMATION
License
ccB
PENDING INSPECTIOI{S
SCHEDULING INSPECTIOT{S
Permit Number: all-19-OO2109-MECH Page 2 of 2
Fee Dcscription
Technoloqy Fee
Balance of minimum permit fees - mechanical
Boiler/compressor/absorptaon system up to 15 HP or 500,000 BTU
State of Oregon Surcharge - Mech ( 12olo of applicable fees)
Quantity Fee Amount
$5.10
$61.00
$41.00
$12.24
$119.34Total Fees:
c:\mytLeport /eporv/prcdu.tron/01 sTAfllDARD
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Crry or SpnrNcFIELD, OnrcoN
Mechanical Permit Application
225 Fif6 Stre€t . Springfield, OR 974?7 . PHl54l)726-3753 . FAX( 54 I )726-368 9
DEPARTMENT USE ONLY
pernritno.: ,\q-qaIoq
,^n, Ql\)Lotl$fr,
This p€rmit is issued under OAR 918-440-0050. P€rmits expire if work is not stsrted within 180 days ofissuance or if work is
suspended for 180 days.
CATEGORY OF CONSTRUCTION
$l Residential ! Govemment E Commercial
JOB SITE INFORMATION AND LOCATION
Job site address ltl/ /'r tl
'crty: furila/1s l/State: 6P-nr: QltJ y'y'
Reference Taxlot.:
DESCRIPTION OF WORK
PROPERTY OWNER
ouata
Name
Address
City:State ZIP
Phorc: fg-ffi- fi( J Fax:
member of my immediate family, and is exempt from licensing
tl a,1
This installation is being made on property owned bv me or a
E-mail
1.010requirements
S
matl.(o
Business name:
Address
Citv:State:
E-mail:
Signature
FEE SCHEDULE
Residential Qty Cost
e&.
Total
cost
First Aooliance 02_00 S
Furnace/burner including ducts and vents
Up to l00k BTU,ftr $23.00 $
s26.00 $
Heaters/stoves/Y€nts
Unit heater s23.00 $
Wood/pellergas stove/fl ue s54.00 $
Evaporated cooler $19.00 $
Vent fan with one duct/appliance $13.00 $
Hood with exhaust and duct $19.00 $
Gas piping
One to four outlets $9.00 $
Additional outlets (each)$5.00 $
Air-handling units, includinq ducts
Up to 10.000 CFM $1s.00 $
Over 10,000 CFM $26.00 $
Comnressor/absorDtion svst€m/heat DumD
Up to 3 hp/I00k BTU s23.00 $
-Up to l5 hp/500k BTU I s41.00 $ Lll
Up to 30 hp/l,000 BTU $61.00 $
Up to 50 hp/1,750 BTU s78.00 $
Over 50 hp/1,750 BTU $r32.00 $
Incin€rators
s26.00 s
Commercial
Enter total valuation ofmechanical system
and installation costs $
Enter fee based on valuation ofmechanical system, etc.$
ItemsMiscellaneous fees Cost
ea.
Total
cost
Reinspection t102.00 $
Specially requested inspections (per ir02.00 $
Regulated equipment (unclassed)t19.00 $
Each additional inspection: ( I )$102.00 $
DEPARTMENT USE
(A) Enter subtotal ofabove fees (or enter set
minimum fee of g 1!a09)$ l0?.--
(B) Investigative fee
(C) Enter l2% surcharge (.12 x [A+B])
(D) Seismic fee, 1% (.01 x [A])$
(E) Technology Fee (5% of IA])$
TOTAL fees atrd surcharges (A through E);$ l\q. zri
CON-TRACTOR INSTALLATIoN
ZIP:
Phone:Fax:
CCB license no.:
Print name:
Over I 00k BTU/hr.
Domestic incinerator
$
$
Insr edited 7/l/2019 BJones
Property Owner Statement
Regard ing Construction Res ponsi bilities
Oregon Law requires residential conslruction p€rmit applicants who are not licensed with the
Conitruclion Contractors Board to sign the following statement b€fore a building permit can be
issued. (ORS 701.325 (2ll
This statement is roquired tor rcsidential building, electrical, mechanical, and Plumbing p€rmits.
Licensed architect and engineer applicants, exempt from licensing under ORS 701.010 (7), need not
submit this stalement This statement will be filed with the permit.
Please check the aPPropriate box
I own, reside in, or will reside in the completed structure and my general contractor istr
Name ccB#Expiration Date
I will inform my general contractor that ail subcontractors who work on the struclure must be
licensed with the Construction Contractors Board.
ol
t----:-l\ I will be performing work on property I own, a residence that I reside in, or a residence that I will
-
-
reside in. lf I hire subcontractors, I will hire only subcontractors licensed with the Construction
Contractors Board. li I change my mind and hire a general contractor, I will select a contractor
who is licensed with the CCB and will immediately give the name of the contractor to the ofiice
issuing this Building Permit.
I have read and understand the lnformation Notice to Homeowners Abou
anJ t frereOy certify that th€ information on this homeowner statement is
/r€kezk
t Construction Responsibilities,
true and accurate.
Print Name of Permit APPlicanl
t9n ature of Permit ApPlicant
q,/2 ,/?
Date
L<.--
Address
\zlssued
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Permil #\q CO^lC]q(^tz\\+H-lcq
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This Copy for Permrt Offices
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