HomeMy WebLinkAboutPermit Mechanical 2016-08-12 (2)GITY OF SPRINGFIELD
Building I Residential Permit
PERMIT NO: 811-SPR2O16-02034
shall remain at the bsite untilfinal i
225Flfth st
Springfleld,OR 97477
Phone: 541-726-3753
IVR Phone: 1 -888-299-2821
Message Phone: 541 -7 26-37 69
permitcenter@spnngfield-or. govwww. sprin gfield-or. gov
PROJECT STATUS:
STATUS DATE:
This Perm or
lssued
08t12t2016
ISSUED:
APPLIED:
08112t2016
08t12t2016
EXPIRES:
IVR REF #:
02t07t2017
811091',t78676
SITE ADDRESS: 750 23RD ST, Springfietd, OR gZ47Z
ASSESOR'SPARCELNO: 1703361209601
PROJECT DESCRIPTION: Kitchen Stove Hood Vent
SCOPE: Mechanical Only
ryPE OF STRUCTURE: Residential
OWNER:
ADDRESS:
Contractor
GREEN JEREMY
750 23RD ST
SPRINGFIELD OR97477
Phone Number:
Lic Type Lic No Lic Exp Phone
000000 08t01t2025
Contractor Name
IVR Code / lnspection Type
2300 Rough Mechanicai Rough Mechanical: prior to Cover
2999 Final Mechanical Final [\4echanical: When all mechanical work is complete.
By signature, I state and agree, that I have careful examined the completed application and do hereby certify that all
lyinformation hereon is true and correct, and I further certify that any and all work performed shail be done in accordance with the
Ordinances of the City of Springfield and the Laws of the State or Oregon pertaining to the work described herein, and that NO
OCCUPANCy wiil be made of any structure without permission of the Current Development Department,Building Safety. I
further certify that only contractors and employees who are in compliance with ORS Chapter 701 wil be used on this project. I
further agree to ensure that ail required inspections are requested at the p roper time, that each address is readable from the
street, that the permit card js located at the front of the property, and the approved set of plans will remain on the site at ail times
durit
or copy thereof, shail remain at iobsite until final inspection.
Owner or Signature tL
Date
^',i[,f
]i,'."+flJj,'.fl !'ii,:"BiI;:Jtili,Notification
":I,^":, Inoi,i,irr_"J lye set torthin OAR es2_oo 1 _o,o.1g th;;;f*, nur_or, -00e0. you may obtain.g.piEi,oj?nl rures bycailins the cenrer. 6,r-ot!,-til,tlilonon"number for ilc*",JiJils%T#*llys1;,*i;,;;;;
Sprinsfietd Buitding permit
NOTISE:
THIS PEHIIIT SHALL EXPIHE IF IHE WORKAUTH0nizED UNDER rHrs primii ri'rvorCCiilI,,{TI{CED OR IS ABANDONED FO;"ANY 180 DAY PER'OD.
CONTRACTOR IN FORMATION
INSPECTIONS REQUIRED
811212016 1:.19:04pM
page 1 of 1
www.springfi eld-or. gov
RECEIPT NO: 2ArcOO2i43
TRANSACTION RECEIPT
81 1 -SPR201 6-02034
750 23RD ST
RECORD NO: 81 1-SPR2O{6-02034
CITY OF SPNNGIIELD
225 Fifth St
Springfield,OR 97477
541 -726-3753
perm itcenter@springf ield-or. gov
a
DATE:08/i2/2016
Continuing Education Fee
First Appliance Fee
State of Oregon Surcharge (12o/o of applicabie fees)
Technology fee (5% of permit total)
224-00000-425606
224-00000-425604
821 -00000-21 5oo4
I 00-00000425605
1 006
1 099
2099
z.5t)
89.00
10.68
4.45
TOTAL DUE:106.63
Card Jeremy Green
763258 106.63
TOTAL PAID:106.63
Mechanical Permit npplication ffi
This permit is issued under oAR 918-440{050. Permits expire if work is not started within rg0 days of issuance or if work issuspended for 180 days.
Dtr-;1s-n-
Permit no
Date:x
dn"riO"*iul -E Government fl Commercial
Job site address: -?$ a3'5'o
City:5gqr-., EcJ)State:4P:1114'r,
Reference:Taxlot.:
-S-ro Ue r{ oO VE qu-{5 €.eTi3flo\-. O.;,i-s r\5
)€-Name:Mvl'7S,c a3'&Address:S'
FrrzlDCity(\State:e-
I Fax:
State:ZIP
Fax:
E-mail:c J-r^
req
QcS rn
meora
licensingORS 70
ZIP: c714 71
This instal ISlation
ofmember my
Business name:
CCB license no.
Phone
Signature
E-mail
Print name
Phone
to 100kBTUAr.$20.00
and
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
One to four outlets
Additional outlets
tol CFM
Over 1 0,000 CFM
unit or system/
fanVent with one
withHood andexhaust duct
$23.00
$s.oo
$23.00
$89.00
Unit heater
$i3.oo
s2s.oo
$20.00
$36.00
$1 15.00
$53.00
$69.00
$2o.oo
$47.00
$16.00
$89.00
$11.00
$16.00
stove/flue
to
cooler
Floor furnace vent
to3
to 15
to 30
to 50
Over 50
OOKBru
750 Bru
,750 BTU
,OOO BTU
BTU
Enter total ofvaluation mechanical systemandinstallationcosts$
etc.
Enter fee based on valuation
$
$89.00 $requested
$89.00 $
$16.00 $Each additional
$89.00 $
Enter(A)ofsubtotal above fees enter(or setfeeof ,5L\$
$12xEntert2%
$1xSeismicfee,O//o
$
$(F)Education Fee $2.s0
$2.s0
throu
TOT,AL fees and
$
4 4o-2 s4 s- r (4 / I /20 t6lcoM)
)-ul.lFi
\A It/
C*-T.f$g.PY.OF
$t--€J.dE Ilrf$.ffi*+i il'tf.o LSe flOlr
.9F;1.WO**-,
on
Address:
Resirle.lltt*l
=*#.'
€ost
tiai
:llgtal
arKf.
Over 100kBTU/hr.
: c ,e*tn
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