HomeMy WebLinkAboutPermit Mechanical 2009-2-12
CITY OF SPRINGFIELD
Building/Combination Permit
. PERMIT NO: COM2009-00209
ISSUED: 02/12/2009
APPLIED: 02112/2009
EXPIRES: 08112/2009
VALUE:
Status
Iss u ed
225 Fifth Street, Springfield, OR
541-726-3753 Phoue
541-726-3676 Fax
541-726,3769 Inspection Line
SITE ADDRESS: 2385 G ST
ASSESSOR'S PARCEL NO.: 1703361115300
Springfield TYPE OF WORK: Single Family Residence
PROJECT DESCRIPTION: gas fireplace stove
TYPE OF USE: New
Residential
Owner:
. Address:
HAWK RANDY A ' .
2385 G ST l"'l':NTION: Oregon law reqUIres you to
SPRINGFIELD OR 97477) .,' ,'N r...i~:s adopted by the Oregon Utility
;,()ti,,~a!ion Center. Those rules are set forth
BERGH LISA Min ONI952-001-001 0 through OAR 952-0(j1-
.2385 G ST, 0090. You may obtain copies of the rules by
SPRINGFIELD OR 97477 calling the cent:r. (Note::.he .t~I~p'ho,ne
Owner:
Address:
IlUlllUvl IVI lll.... '-',......tt'"'., ......".] ..........--..-..
I cf>NTRAcTOR1NFORMAlTlON ,
Contractor Type
Mechanical
'Contractor License
EMERALD SWIMMING POOLS OF ORE IN 112~4
I BUILDING INFORMATION~
# of Units:,
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
# of Stories:
~~3)TICE: Height ~f~iructure .
THIS PERMI1m~Atl!:'etrIRE IF THE WORK
/l,UTHORIZEo'YJ',t,c,'jfffi'PffiIS PERMIT IS NOT
COMMENCE\~~~J.?l~~~NDONED FOR
ANY 180 DAspii~liJi~dlBuilding: '. nla
I, DEVELOPMENT INFORMATION I
Froutyard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
0/0 of Lot Coverage:
I PUBLIC IMPROVEMENTS I
Street Improvements:
Storm Sewer Available:
Speciallnstructiou:
Expiration Date
10/22/2009
Phone
541-688- 1090
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft GaragelCarport
Sq Ft Other:
Occupant Load:
REQUIRED PARKING
Total:
, Handicapped:
Compact:
Sidewalk Type:
Downspoutsillrains:
Noles:
Pa2e 1 of 2
Status
Issued
CITY OF SPRINGFIELD.
Building/Combination Permit
PERMIT NO: COM2009-00209
ISSUED: 02/12/2009
APPLIED: 02/1212009
EXPIRES: 08/12/2009
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone '
541-726-3676 Fax
541-726-37691nspection Line
,I Va]~ation DescriDtion ..1
DescriPtion
, Type of Construction
$ Per Sq Ft
or multiplier
Sqn,are Footage
or Bid Amount
Valne
Date Calculated
Total Value of Project
'I Fe~.s Paid I
Fee Description
+ 12% Sta'te Surcharge
+ 5% Technology Fee
I st Appliance
Amount Paid
Date Paid
$9.48
$3.95
$79.00
2/12/09
2/12/09
2/12/09
Receipt,Number
2200900000000000170
2200900000000000170
2200900000000000170
Total Amount Paid
$92.43
I Plan Reviews I
To Request an inspection call the 24 hour recording at 726-3769. All inspections 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 Re,'uired Insnections'.
111.111 III I ill
Rough Mechanical: Prior to Cover
Final Mechanical: When all mechanical work is complete.
By signature, I state 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 Spriugfield 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 readable 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
times during construction.
\' L d-("d-rJ9
Owuer or coptors Signature
Date
Paee 2 of 2
225 Fifth.Street
Springfield, Oregon 97477
541-/16-3759 Phone
Job/Journal Number
COM2009-00209
COM2009-00209
COM2009-00209
Payments:
Type of Payment
Check
cReceintl
RECEIPT #:
Description
1st Appliance
+ 5% Technology Fee
+ 12% State Surcharge
Paid By
LISA HAWK
City of Springfield Official Receipt
Development Services Department
Public Works Department
2200900000000000170
Date: 02/12/2009
11 :55:44AM
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
Amount Due
79.00
3.95
9.48
$92.43
Amount Paid
cjc
1022
$92.43
$92.43
In Person
Payment Total:
Page I of I
2/1212009
1r,.~~~'eA!i1EG0R"'~0FRtc0NsmRUcmI0N~~'1!'ii!!kilJi):l. :K~'It!!I\!l&~'1~~;;J~EE1T~reHED8i!El1!~!"i>\1!I#kI}~.li1
&'i~4K\!1lIwlQ€4'Jt.."^..~.".."."_,.."..".,,.,,Ji!___""""___A^,"-_,..__-,-_,aL"~_,;,~'f",,~~ ,J!<."w!;)fKiffl;~~~-.')'t"-,L.__,,,,,~,_,__,_,,_,.,..I',,,,~_~~~W~~
1 0 Residential l 0 Government. .1 0 Commercial !~Rigid~rt~ltit~~'iJ~~~~~~~~Wff~ltQ';~I!!~.'!aI~;1l[tiitl,ll
",>.",..,,,,.~~,,,,~.,-,,,_~.~l[gk"""'__~1.,'l:.1:\'''~;'':':'t:r,!!'~ ".=,~~:j :'~l:"Gea.,.,_.",,,, ~cos ,:::1-.,;:- .
1~,j;!!1~l!i0B:"SIir:E!!iTN"ORliJiA'iii0NrA;:;iD''!iloCA;iii0r:F'"~it'cl First Appliance I I $79.00 $ '7'" -r.
)&~[~~,~_~_J~.a~..t...t-'''''_.~..;}~'~'m",_""-A4'_._._.<>_'l;..'-\-,_~nj)""'h.."~_...__~,_~~,."_,~~"",,.,,J~: I
1 Job site address: ').:3 YS C; 1 iFurnace/burner including ducts and vents
I City: 9/'Ft...D 1 Stat'"~n:. I ZIP: '7'7/(1)7 1 I Up to lOOk BTU/hr. I
1 1 1 lOver lOOk BTUlhr. I
Subdivision: . Lot no.:
11!Il:\"!-~'llIi~~i"~--~--"'C-'^'-';="~^"'---" '-^.'~"'~"'''''i$'''''"1lI1 I Heaters/stoves/vents
~!!Z!0'1d;11Y;l!7iJ~~SC~IH;ji!S!~.tl:::!!iillV\LQ8!5'41illl!i.~,~f,.iliii,:*~1 Unit heater
n Ii-.::-,pu12-';; 5;(0 Vb ((:,;...5 1 (Wooa/pelietlgassio~~fiue> '.
-Repair/alter/add"to heating appliance/
refrigeration unit or cooling system!
absorption system
I Evaporated cooler
I Vent fan with one duct/appliance vent,
I Hood with exhaust and duct
I Floor furnace including vent
I Gas pipin~
lOne to four outlets I .1
I Additional outlets (each)
I Air-handlin~ units, includin~ ducts
I Up to 10,000 CFM I I $11,00 I $
lOver 10,000 CFM . $20.00 $
I Compressor/absorption svstem/heat pump'
I Up to 3 hplIOOk BTU $17.00 $
1 Up to 15 hp/500k BTU $29.00 $
I Up to 30 hplI,OOO BTU $43.00 $
I Up to 50 hplI,750 BTU $57,00. $
lOver 50 hp/I,750 BTU $95,00 $
I Incinerators
Domestjc incinerator
I
Enter fee based on valuation of mechanical system, etc. $ I
~Mi~i:"ij"~fi'1l11~fr~'='~~'~~1i~IWli;lrl!~~iill~ ~~1i.ii.ta~~1
:tri\:~'i"b{:;~!.""'W':lir./ilC8;':1,t.."iillV\!i>i'.:tjJ~'"",~~;,,-Y;Bl'1 -;r~~ iJf:;f$l.ea~318 tl~cost~
I Reinspection $58.00 $ I
I Specially requested inspections (per hr.) $58.00 I $ I
I Regulated equipment (unclassed) I $13.00 $ I
~;~~;~ko~ff~~ANff~~m$~~~~.~~:
I (A) Enter subtotal of above fees (or enter set 7' 0" 1:1
minimum fee of $ 79.00) $ 1 ..---
I (B) Investigative fee (equal to [A]) $
I (C)EnterI2%surcharge(.12x[A+BD $t1~
I (D) Seismic fee. 1% (.01 x [AD $
I (E) Technology Fee (5%0f[A]) $ <;:0
I TOTAL fees and surcharges (A through E): $ '12 'i'
Mechanical Permit Application
D .
..._ .1 ..."J....t\"'~"
225 Fifth Street. Springfield, OR 97477 . PH(541)726-3753 . FAX(54t)726-3689
'~i!~~DEPARlfMEN[~wsEJ0N[!:'y;,ltii!;W1
FR~,,1::>.11,,"'-:'!:.~:";4'1:;;:':Ii1;i1l'i;:'kffH;u\:,i1:~~~"ii1~3!:"K~'11\;
I
I
Permit no.: iF? - ;Lc:J Y
I Date: 2-//2./ CJ 7'
This permit is issued under OAR 918-440-0050. Permits expire if work is uot started within 180 days of issuauce or if work is
suspended for 180 days.
$17.00 I $
$20.00 $
$17.00
$38.00
$58.00
Name: [, Srt- /7/1'W~
1 Address: SA-,v\..;::::-
I City:
1 Phone:)YI-n;. II iJ ~
1 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.
I State:
1 Fax:
1 ZIP:
$13.00 $
$9.00 $
$13.00 $
$58.00 $
$7.00 I $
$4.00 $
Signature:
1!h~~CoNmIt6:Cm0~R~NS;FA[~Affii0N~;ll&~-'f.fl,:~~
%~:a:r~;B'ifu1f""_"'""'^"'"""''"''-"___'''-"''_'~M_'''''''M-''''_"'_:'J.,.^_,",,_..~-<M.._,,-___,,~~r);~>- '1'f;'l~"",
1 Business name: f7Yl.c.:?2-,q-t... D /0<,,-
1 Address: 1'/["'6'>' 1-fz,J( '7 '7 tv"
1 City:E'U. C 1 State:
1 Phone: ~f6 /0") 0 I Fax:
I E-mail:
I CCB license no.:
I Print name:
I Signature:
/, /'/9-
1 ZIP:'!7lrO'2-
)1 ?~JL)
r
Enter total valuation of mechanical system
and mstallation costs $
440-2545-J (ltIOS/COM)
$
$
$
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