HomeMy WebLinkAboutPermit Mechanical 2009-7-31
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Mechanical Permit Application
225 Fifth Street. Springfield. OR 97477. PH(541)726-3753 . FAX(541)726-3689
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permitno.,l !Cj ~ ()IIO (I
I Date: '7 ~ 2/--- 0'7 I
This permit is issued under OAR 918-440-0050. Permits expire if work is'not started within 180 days of issuance or if work is
suspended for 180 days.
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1 0 Residential I 0 Governmenl .1 0 Commercial _
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1 Job site address: '-fiR Ljt" u" ;0'1
1 City: 50": - 1 StateD....- 1 ZIP: C((y 7 "
Subdivision: I Lot no.:
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I Name: "'-0...., ~,l\~~....,s
I Address: <-t&-'lb U (\10'"
I City: S (.. I State: c;v
I Phone: 1 Fax: ,
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,
Signature:
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Business name: (/"" W QS), ~." ~ _ 1
I Address: \501>;'" C, 0 e.,J...- 1
I City: ()"-~ 1 Stale:0.- I ZIP:G1,H/' I
I Phone: . -.'5"Cr/ -520 nlfl 1 Fax: I
I E.mail: I
I CCB license no,: r 1"7 043 I
I Print name: C. "'At. \L- \-\ ~~o I
/Signature ~,()~~ \..J_~ I
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1 ZIP: q7l/ 1S-
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440-2545-J (lll08/COM)
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I First APPliancec,'l,ll: """"';;I:~;;~~~--'- ";"c/'t"'"'1
lFurnace/burner i.neluding ducts and vents I
I Up to lOOk BTlJ/hr. I $17.00 I $ I
lOver lOOk BTU/hr. I $20.00 $ I
I Heaters/stoves/vents I
I Unit heater $17.00 $ I
I Wood/pellet/gas stove/flue $38.00 $ I
I Repair/alter/add to heating appliance! I
refrigeration ,unit or cooling system! $58.00 $
absorption system .
I Evaporated cooler $13.00 $ I
I Vent fan with one duct/appliance vent $9.00 $ I
I Hood with exhaust and duct $13.00 $ I
I Floor furnace including vent $58.00 $ I
1~~~2 I
lOne to four outlets I I $7.00 I $ I
I Additionai outlets (each) $4.00 $ I
I Air-handling units, including ducts I
I Up to 10,000 CFM I I $11.00 I $ I
lOver 10.000 CFM $20.00 $ I
I Compressor/absorption svstem/heat pump I
I Up to 3 hpllOOk BTU $17.00 $ I
I Up tol5 hp/500k BTU $29.00 $ I
Up to 30 hpll,OOO BTU $43.00 $ I
I Up to 50 hp/1.750 BTU $57.00 $ I
lOver 50 hpll,750 BTU $95.00 $ I
I Incinerators I
I Domestic incinerator
I Enter totaJ valuatjon of mechanical ~ystem
and installation costs $ _
I Enter fee based on valuation of mechanical system, etc. I $
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Reinspection I $58.00 $ I
I Speciaiiy requested inspections (per hr.) I I $58.00 $ I
I Regulated equipment (unclassed) I $13.00 I $ I
addilional inspection: (I) I $58,00 I $ I
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I (A) Enter subtotal of above fees (or enter.set
minimum. fee of $ 79;00)
I (B) Investigative'fee (equal to [A])
I (C) Enter 12% surcharge (,12 x [A+B])
I (D) Seismicfee, 1% (,01 x [A])
I (E) Technoiogy Fee (5% of [A])
I TOTAL fees and surcharges (A Ihrough E):
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'1 '71' (
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$
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Status
Issued
CITY OF SPRINGlflJ<;LD .
Building/Combination Permit
PERMIT NO: COM2009-01109
ISSUED: 07/31/2009
APPLIED: 07/31/2009
EXPIRES: 01/31/20JO
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 4646 UNION TER
ASSESSOR'S PARCEL NO.: 1702324308602
Springfield TYPE OF WORK: Heating System
TYPE OF USE: New
Residential
PROJECT DESCRIPTION: Heat Pump
Owner: WILLIAMS JOY A
Address: 4646 UNION TER
SPRINGFIELD OR 97478
I CONTRACTOR INFORMATION I
Contractor Type
Mechanical
Contractor License
PAC WEST HEATING 117043
BUILDING INFORMA nON.
Expiration Date
10/17/2010
Phone
541-937-2859
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type: '
# of Bedrooms:
# of Stories:
Height of Structure
Type of Heat:
Water Type:
Range Type:
Energy Path:
Sprinkled Building:
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
n/a
I DEVELOPMENT INFORMA nON I
REQUIRED PARKING
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Overlay'Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
Total:
Handicapped:
Compact:
I PUBLIC IMPROVEMENTS I
Street Improvements:
Sidewalk Type:
Storm Sewer Available:
Special Instruction:
NOTICE:
NoteS:THIS PERMIT SHALL EXPIRE IF THE WORK
^ll-r. '1"'..........__ ..
.'-'''V'''L~'-' '-'Iwen InI" t'ttilVIII !:.. ;';UI in OAR 952-001-0010 through OAR 952-001-
. COMMENCED OR IS ABANDONED ~(Maluation DescriDtion 10090. You may obtain copies of the rules by
ANY 180 DAY PERIOD. calling the center. (Note: the telephone
. . ,$ Per Sq Ft Square Fontageber for the Or.Anon Utility N"tif;~pti()n
DescrIPtIOn Type of ConstructIOn . . '. '1.. " Value Date Calculated
, or multlpher or BId Amount Center IS l-bOO-332-2lj4'l).
Downspouts/Drains:
ATTENTION: Oregon law requires you to
follow rules adopted by the Oregon Utility
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Page 1 of2
Status
Iss u ed
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Total Value of Project
Fees, Paid I
Fee Description
+ 12% State Surcharge
+ 5% Technology Fee
1st Appliance
Amount Paid
Date Paid
$9.48
$3,95
$79.00
Total Amount Paid
$92.43
I. Plan Reviews I
7/31/09
7/31/09
7/31/09
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-01109
ISSUED: 07/3112009
APPLIED: 07/3112009
EXPIRES: 01/31/2010
VALUE:
Receipt Number
1200900000000000860
12009000000Q0000860
1200900000000000860
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.
Rel1ll! 're,i J - ~,nections.
111110111111.: 111I.il.
Rough Mechanical: Prior to Cover
Final Mechanical: When all mechanical work is complete.
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 I 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 ofa~y structure without permission ofthe 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 durin;::\;nsrT(tion; w~
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Owner or Contractors Signature -~-' Date
Page 2 of2
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2009-0 11 09
COM2009-01109
COM2009-0 II 09
Payments:
Type oc.Payment
Check
cReceint 1
RECEIPT #:
Description
1st Appliance
+ 5% Technology Fee
+ 12% State Surcharge
Paid By
PAC WEST HEATING & A/C
City .of Springfield Official Receipt
Development Services Department
Public Works Department
1200900000000000860
Date: 07/31/2009
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
nJm
976
In Person
Payment Total:
Page 1 of I
3:1O:32PM
Amount Due
79.00
3.95
9.48
$92.43
Amount Paid
$92.43
$92.43
713 l/2009