HomeMy WebLinkAboutPermit Mechanical 2019-09-17OREGON
Web Address: www.sprangfi eld-or.9ov
Building Permit
Residential Mechanical
Permit Number: 811-19-OO2l42-MECH
M Number: 81r082191398
City of Springfield
Development and Public Works
225 Flfth Street
Springfield, OR 97477
54r-7 26-37 53
Email Address: permitcenter@springfield-or.gov
SPRINGFIELD
'!f
Permit lssued: September 17, 2019
Category of Construction: Single Family Dwelling
Submitted Job Value: $0-00
Description of Work: Relocate kitchen vent & new hood
Type of Work: Alteration
worksite Address
3858 LONG RIDGE DR
Springfield, OR 97478
Parcel
1802061310007
Owner:
Address:
PLUEARD ]EFFREY J &
WENDY K
3858 LONG RIDGE DR
SPRINGFIELD, OR 97478
Buslness Name
OWNER - Primary
License
CC8
License Number
000000
Phone
lnspection
2999 Final Mechanical
2300 Rough Mechanical
Inspection Gaoup
Mech Res
Mech Res
lnspection Status
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 www. build ingpermits.oregon.gov
Call or text the word "schedule" to 1-888-299-2821 use IvR number: 811082191398
Schedule using the Oregon ePermitting Inspection App, search "epermitting" in the app store
Permlts exphe It worl is not started wlthln l8O DayE of lssuance or lf work ls suspended for l8O oays or longer delrendlng on
the lssulng agency's policf.
All provblons of l.ws and ordinanccs gov.mlng thls type ot work will be cornplled wlth whether sp€cllt€d h€r€ln or not.
Grantlng of a p€rmlt does not prcsume to Clve euthorlty to violate or cancel the provlslons ofany oth€r state or local law
regulatlng construction or t re pcrlorm.nc. of consEucton.
ATTET{TIoI{: or€gon law requlres you to tollow rules adopted by the Oregon Udllty iotiticadon Center. Tho5G rulcs.t€ set
forth ln OAR 952-OOt-oo10 through OAR 952-OOl-OO9o. You ftay obtaln copler ot the rules by calllng the C.ntcr.t (503)
232-L9A7,
All pe.sons or €ntities performlno work under thls p.rmit are r€quircd to be llcens€d unless exemPt€d by ORS 70l.0lO
(Structural/ltlechanical), ORS 479,54O (Elcctrlcal), .nd ORS 593.O10-020 (PlumblnC).
prnted on; 9/17119 page I of 2 c:\mYRepods/r€port5//prcdlction/01 STANDARD
TYPE OF WORK
,OB SITE I FORMATION
LICENSED PROFESSIO AL IT{ FORMATION
PENDING INSPECTIONS
SCHEDULING INSPECTTONS
Permit Number: a 11- 19-OO 2142-M ECH Page 2 of 2
Fee De3crlptlon
Technology Fee
Balance of minimum permit fees - mechanical
Range hood/other kitchen equipment
Ventilation fan connected to single duct
State of Oregon Surcharge - Mech (12olo of applicable fees)
Quantity Fee Amount
$5.10
$70.00
$19.00
$13.00
$12.24
$119.34Total Fees:
c:\myReports/pports//prcductiorv01 STANoARo
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Mechanical Permit Application
GATEGORY OF CONSTRUCTION
Besiden tial E Govemment E Commercial
JOB SITE INFORMATION AND LOCATION
Job site address: 3^59 )!r*- R. )-" -D r
City 1j 6^$1 I Vor", fi nYq?L)+V
(J
Reference Taxlot.
DESCRIPTION OF WORK
Ro )n"n*" X.'+L.. )^r'n1 t,re.,^t
PROPERW OWNER
Name t
City:
Phone:
E-mail
This ins
member
tlon made on o wned by me or a
o f m v immed iate famil v from I I !^ens ln c
requrremeots R 010.
Signature
&HihAcron TNSTALLAnoN
Business name T__-\
City:ZIP
Phone Fax;
)
Print name:
Signature
FEE SCHEDULE
Residential Qty Cost
ea.
Totsl
cosl
First Anrrliance i102.00 $,
Furnace/burner including ducts and vents
Up to 100k BTU/hr s2-1.00 $
Over l00k BTU/hr s26.00 s
Heaters/stoYes/vents
Unit heater 523.00 $
Wood/pellet/gas stove/fl ue s5.1.00 5
Evaporated cooler s19.00 $
Vent tan with onc duct/appliancc I sll.00 $
Hood with exhaust and duct t s19.00 $
Gas pipinq
One to four outlets i9.00 s
Additional outlets (each)$5.00 $
Air-handling units, including ducts
Up to | 0.000 CFM $ 15.00 5
Over I0,000 CFM t26.00 S
Comoressor/absorotion svstenvheat DumD
Up to 3 hp/100k BTU s21.00 $
Up to 15 hp/500k BTU 5.11.00 $
Up to 30 hp/1,000 BTU s61.00 5
Up to 50 hp/1,750 BTU s78.00 $
Over 50 hp/1,750 BTU s 132.00 $
Incinerators
Domestic incinerator $26.00 $
Commercial
Enter total valuation of mechanical system
and installation costs $
-
Enter fee based on valuation ofmechanical system, etc $
Miscellaneous fees Items Cost
ea.
Totsl
cost
Reinspection i 102.00 $
Specially requested inspections (per ;t 02.00 S
Regulated equipment (unclassed)ils.00 $
Each additional inspection: ( l)i102.00 $
DEPARTMENT USE
(A) Enter subtotal of above fees (or ent€r set
minimum l'ee of $ 102,00)s
(B) [nvestigative fee 5
(C) Enter l2yo surcharge (.12 x [A+B])5
(D) Seismic fee, l% (.01 x [A])5
(E) Technology Fee (5% oflAl)s
TOTAI, fees atrd surcharges (A through E):$1(1. jt
cn,
)
225 Finh Sue€l . Springfield. OR 97477 . PH(541)726-3753. FAX(541 )726-3689
This permit is issued under OAR 918-440-0050. Permits expire if work is not started wifhin 1E0 days of issuance or if work is
suspended for 180 days.
DEPARTMENT USE ONLY
Permitno.: n-1Tl ,1 )-Mlt
Date:q rtr{ tq
trsl edired 7,1/2019 BJoncs
Crrv oF SPRTNGFTELD, OnBcoN
Address: ? ? (9. L,s- I
so'4,,ryp ZlP:qaq?V
Fax:
Address:
(")-
CCB license no.:
ProPefi Owner Statement
Regarding Construction Responsibilities
Oregon Law requires residential construction permit appiicants who are not licensed wilh the
Conitruclion Contractors Board to sign the following statement before a building permit can be
issued. (ORS 701.32s (2))
This statement is required tor residential building, olectrical, mechanical, and plumbing pormits.
Licensed architect and engineer aPplicants, exempt from licensing under ORS 701.010 (7)' need not
submit this statement. This statement will be filed with the permit'
Please check the apPropriate box
CCB#Expiration Date
X
lwill inform my general contractor that all subcontractors who work on the slructure must be
licensed with the Construction Contractors Board.
or
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, lwill hire only subcontractors licensed with the Construction
Contractors Board. lf 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 undeEtand the lnformation N
and I hereby certify that the information on th
otice to Homeowncis About Construction ResPonsibilities'
is homeowner statement is true and accurate.
l.^r ,"-l
Print Name of Permit APPlicant
Sign rmit Applicant Date
4A\q{A-
36sB
tqlssued by Date
\q -o6\q k|)-
ql,t
Permit #
Address
This Copy for Permit Offices
I own, reside in, or will reside in the completed struclure and my general contractor is:
Name
L_l
x*
Homeowners acting as their own general contracto6 to construct a
or make a substantial improvement to an existing structure, can prevent
by being aware of the following resPonsibilities:
lnformation Notice to Owners About
Construction ResPonsibi I ities
(oRs 701.325 (3))
new home
many problems
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Homeowners who use labor provided by workers not ticensed by the Construction Contractors
Board, may be considered an employer, and the workers who provide the labor may be considered
employees. As an employer, you must comply with the following:
oregon,s withholding Tax Law: Employers must withhold income taxes from employee wages
at th-e time employees are paid. You will be liable for the tax payments even if you don't actually
withhold the tax from your employees. For more information, call the Department of Revenue at
503-378-4988.
Unemployment lnsurance Tax: Employers are required to pay a tax for unemployment insurance
prrpo"e" tn the wages of all employees. For more rnformation, call the Oregon Employment
Department at 503-947-'l 488.
oregon,s Business ldentification Number (BlN): is a combined number for both oregon
Wthholding and Unemployment lnsurance Tax. To file for a BlN, go online to the Oregon Business
Registry. For questions, cail 503-945-8091 .
Workers Compensation lnsurance: Employers are subiect to lhe Oregon Workers Compensation
Law, and must obtain Workers Compensation lnsurance for their employees. lf you fail to obtain
Workers Compensation lnsurance, you could be subject to penalties and be liable for all claim costs
if one of your workers is injured on the job. For more information, call the Workers Compensation
Division at the Department of Consumer and Business Services at 800452-0288.
Tax Withholding: Employers must withhold Social Security Tax and Federal lncome Tax from
employee wages. You may be liable for the tax payment, even if you didn't actually withhold the tax.
For a Federal EIN number, go online to www. irs.oov.
CONSTRUCTION CONTRACTORS BOARD
PO Box 14140, Salem. OR 9730c.5052
Telephone: 50+378-4621 - Fax: 5o!37T2@7
V\iebsite Address: www.oreoon.oov/ccb
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Other Responsibilities of Homeowners:
Code Compliance: As the permit holder for a constructron project, the homeowner is responsible
for notifying building officials at the appropriate times, so that the required inspections can be
performed. Homeowners are also responsible for resolving any failure to meet code requirements
that may be found through inspections.
Property Damage and Liability lnsurance: Homeowners acting as their own contrac"tors should
contacl their insurance agent to ensure adequate insurance coverage for accidents and omissions,
such as falling tools, paint overspray, water damage from pipe punctures, tire, or work that musl be
redone. Liability lnsurance must be sufficient to cover injuries to persons on the job site who are not
otherwise covered as employees by Workers Compensation lnsurance.
Expertise: Homeowners should make sure they have the skills to act as their own general
contractor, and the expertise required to coordinate the work of both rough-in and finish trades.
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This Copy for Permit