HomeMy WebLinkAboutPermit Mechanical 2009-8-4
-', . ' -
Mechanical Permit Application'
225 Fifth Street. Springfield. OR 97477 . PH(541)726-3753 . FAX(541)726-3689
~~~~0j,"':1;;";(.:";'C;.'ii;lt1;..:~t,,*,'%'<t~~;~~1,.~~!I';i"'~1
;;"~i'llPE,:P'AB;Tl\IIli.Nrr"I1SElpN,",Y", "
?'!'",.,.~"t.~'''-'''''c:.'t""''dl.fjf.""...~..<J.JW..'~~,''~~*,^",,, .~.!!i..
I
I
Penn it no: cY9 - 112 t.f
I Date:
f!'l/o~
This permit is issued under OAR 918-440-0050. Permits expire if work is not started within 180 days ofissuance or if work is
suspended for 180 days.
1~~+:;jGAmE(r0RS',foE''':C{0NsmRill€1;10N''?'''~W;If!~1
~~~."-A'n&"',',""a,~_,_,".i.~~,.,.,'it:4!._._.._._,.~t:.:~,_,.,,,,,tl.+-;..\..~-,,~,~~';.,~~._;;:;.-~.
j'iiJ'Residential I 0 Government I, 0 Commercial 1
~~0B"!\rS1IJiE'']IN~ORMA;tr0NI\'1\t;rD:;1!C'Cw;m0N;r,~e;,f\;
~~___,_:!EA_'"''~'~''_'~'--_'_'u_.......__...,.,.,,,,.b''''''' .',,"'. "'''''__..,_.._.~_.,._~~.-".,,'_...,,~_._ .<.-,...,...",...,'0,,~,....4?j<..
I Job site address: _ <J, 4S M/h1-SJ'it'it!
1 City: /5..oJ1/ _ I'State: 0 (. l ZIP: /7 'f7? 1
SUbdivisio~:V1\JJ'):')r'~ q tiil~ _
~~&'~~~];fDES'CRIF!iiiI0NWJ;lIiWORKii1f~~1~~:C\!:r;,~
tm~~\7:-fW67~ ;;~""c~~~;;;;7) ~;;:::?"
A-WMI (?td/rf'5.
1 Address: JI/:J- ~.J f-,d/
1 City: _cp J/J 1 State: c/ (. 1 ZIP:
, Phone: - -- - '7'1?- diP 71 1 Fax:
I 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 Name:
1
"17'1?;
Signature:
~"":f...>>g.l:l~~.3C0NmAAeii0R"'li\iS:fAI!I!A:i1i0N~~~\1(~JF,.\
~~-tii'..~~._._.:N_.__~...~:h_..,_t!_~~_"_'"_:'~_'_~'~'0~~~"''-l~>:;:\
I Businessna,;,e: /fnb,:l.,5SQh( e'(?;!:) ,
1 Address: CWi 61Y; r L #f2 I
I City: 5PJfJ 1 State: I ZIP: C) 'J1/7/ 1
I Phone: - - - '72(,6?;Jg I Fax: 1
I E-mail: I
I CCB license no.: 1";;<.1 l( (P, ., I
1 Print name: ~ _ M~1:f4/;e.J <5 aU0-7~,.,1 1
I 'Signature: !I/~~ I
"~<
~'b 'd-f\.\
\S)V.6\
eo~Q/
~
440-2545-) (11/D8/COM)
~"t41\'-'''''~U___-'--~''''-'--'--.--,,~__'I;lII!li!''
\ii<1i,i~~~X:.ll;"Il~~~I::!=-,l(~p-',fJ;I;JJ;!~I;~!~~WgJ:c_\\!l!
;)"R''''''':~'d''-~t'''!I'i\~i~\if;\\~{B1li.''~:r~~i';~i\jJ "Q"'t'"~\llf;1iCiiSJJi:-iI~Tota I~
fY,iJ't~J~.,,,~~>~~;~J~~frJ~{~\t~~:,~tZ!~~Jt~'..'_~~;: ;~,~~ ~e'~~ mcost@k~
First Appliance $79.00 $ n'O<::.
\Furnace/burner including ducts and vents I
I Up to lOOk BTU/hr, I $17.00 I $ I
lOver lOOk BTU/hr, I $20.00 $ I
Heaters/stoves/vents I
I Unit heater $17.00 $ I
Wood/pellet/gas stove/flue $38.00 $ I
'Repair/alter/add t,a.heating appliance! I
refrigeration unit or cooling system! $58.00 $
abs~rption 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 Gas piping I
, One to four outlets I I $7.00 I $ 7~ I
Additional outlets (each) $4.00 $ I
Air-handling units, including ducts I
Up to 10,000 CFM I I $11.00 I $ I
lOver 10,000 CFM $20.00 $ I
I Compressor/absorption system/beat pump I
I Up to 3 hpll OOk BTU I $17.00 $ I
Up to 15 hp/500k BTU $29.00 $ I
I Up to 30 hp/I,OOO BTU $43.00 ,$ I
, Up to 50 hpll, 750 BTU $57.00 $ I
lOver 50 hpll,750 BTU $95.00 $ I
I Incinerators I
I Domestic incinerator $ I
Enter total valuation ofmechanicaJ system I'
and installatIOn costs $
Enter fee based on valuation of mechanical system, etc. $ I
Wf!M"~"'''''-II' -fi!lC~-f'..',!!'r~1I-.)Jii!~t~\;";~"it~l~el€iisFil\!i\ ~Totiil;'.J
r,~;n-hl~i~~.\O!}l~~t~9~~1q~M,~gf:~~ 'z~~ ~4qea'~~l ~co'si~-';I
I Reinspection $58.00 $ I
I Specially requested inspections (per hr.) $58.00 $ I
l Regulated equipment (unclassed) I $13.00 I $ I
I Each additional inspection: (I) I $58,00. $ I
1~_,.''iJ4j1'0_ ,.. . ....ii~gp.iHGANiTi~EfsE~~~Oli'~.- ;-.--;~ i'i;1
_."'.....~i~~~~~I1.,. k.__...._...._,_.t.__._.._"..j,).)i~~~~~;y
(A) Enter subtotal of above fees (or enter set I "0 I
minimum fee of $ 79.001 $ oC/
l (B) Investigative fee (equal to [AJ) I $ I
I (C)EnterI2%surcharge(.12x[A+B]) ,$ I
I (D) Seismic fee, 1 % (,01 x [A]) I $ I
l (E) Technology Fee (5% of [A]) I $ I
I TOTAL fees and surcharges (A through E): I $ I
reS 't5
. .
-~~-~~~aF;~,!~~-~.f
'Jll$ 't',.
~1' "
Status
Issued
CITY OF SrK11"GFIELD
Building/Combination Permit
PERMIT NO: COM2009-01124
ISSUED: 08/04/2009
APPLIED: 08/04/2009
EXPIRES: 02/0412010
VALUE:
\
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 345 MANSFIELD ST
ASSESSOR'S PARCEL NO.: 1703233405300
Springfield TYPE OF WORK: Single Family Residence
TYPE OF USE: Alteration
Residential
PROJECT DESCRIPTION: WATER HEATER AND GAS PIPING
Owner:
Address:
PHILIPS ALFRED R & LA THERA
345 MANSFIELD ST
SPRINGFIELD OR 97477
............,.-UTI^I\l. f""\mnrm !::\w reauires you to
,.. ~,~'~..l~" "'",,IM'! hll the Oreqon UlIlIlY ,
~01;:I:CONTRACI;OR-INF,0RMA'f<ION 1.,rth
, o~AR 952-001-0010 througn u"n "'J~-v01- ,
.Contractor ~090 ,You may obtain copies (Li~en's~'lS bYExpiration Date
AMBASSADOR plgi!':lq INCcenter. (Note:thrl~!~(9'10;.en 03/27/2011
BARNES HIGH 'fI!dGH'P.IlUMB]NG'(~<;' ~~~\~~~~XI Ica 10 02/17/2010
Phone
541-726-5723
541-726-9854
Contractor Type
Mechanical
Plnmbing
BUILDING INFORMATION I
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
# of Stories: Lot Size:
Height of Structure Sq Ft 1st Floor:
Type of Heat: Sq Ft 2nd Floor:
Water Type: Sq Ft Basement:
Range Type: Sq Ft Garage/Carport
Energy Path: Sq Ft Other:
NOTICSprinkled Building: n/a Occupant Load:
T~~: :'~::~.~~: ~~~:~'-,"- ~~.~~~': !f :~~: \N~r:.:~
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
I~D~V;EI;0P'MENJlllNF0~~Aif.ION:.IS NOT
COMMENCED OR IS ABANDONED FOR
ANY 180{erla}l'=D.f~i:')D.
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
REQUIRED PARKING
Total:
Handicapped:
Compact:
I PUBLIC IMPROVEMENTS I
Street Improvements:
Storm Sewer Available:
Special Instruction:
Sidewalk Type:
Downspouts/Drains:
Notes:
Paee I of3
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
I Valuation Descrintion ,
Description
Tvpe of Construction
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Total Value of Project
F1P<' f'jW
Fee Description
+ 12% State Surcharge
+ 5% Technology Fee
1st Appliance
"Fixtnre
Gas Outlets 1-4
Minimum/Adjustment Plumbing
Amount Paid
$17.28
$7.20
$79.00
$19.00
$7.00
$39.00
, Total Amount Paid
$168.48
I Plan Reviews ,
Date Paid
8/4/09
8/4/09
8/4/09
8/4/09
8/4/09
8/4/09
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-01124
ISSUED: 08/0412009
APPLIED: 08/04/2009
EXPIRES: 02/04/2010 "
VALUE:
Value
Date Calculated
Receipt Number
1200900000000000874
1200900000000000874
1200900000000000874
120090000000000~874
1200900000000000874
1200900000000000874
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 Rpllllirprl In~lPr.tin~
Rough Plumbing: Prior to cover and including required testing.
Final Plumbing: When all plumbing work is complete.
Rough Mechanical: Prior to Cover
Rough Gas: After line is installed and required testing and capped if not attached to an appliance.
Final Gas: When all gas work is complete.
Final Mechanical: When all mechanical work is complete.
Paee 2 of 3
-~~1~,9r;!~'.~
:fll;" .
-f~"
Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-01l24
ISSUED: 08/04/2009
APPLIED: 08/04/2009
EXPIRES: 02/0412010
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
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 sball be done in accordance with
tbe Ordinances of the City of Springfield and the Laws of the State of Oregon pertaining to the work described herein, and
tbat 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 tbe permit card is located at tbe front of the property, and the approved set of plans will remain on the site at all
times during construction.
n:;#b ~/~
Owner or Contractors Signature
Date
Pal!e 3 of 3
2i5 'Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2009-01124
COM2009-01124
COM2009-01124
COM2009-0 1124
COM2009-01124
COM2009-01124
Payments:
Type of Payment
CreditCard
cReceinll
RECEIPT #:
"._~,."'''''','' ", ~D. ."jj.." .. .,...,
a
=~..... .'
City of Springfield Official Receipt
Development Services Department
Public Works Department
1200900000000000874
Date: 08/04/2009
Description
Fixture
Minimum/Adjustment Plumbing
I st Appliance
Gas Outlets 1-4
+ 5% Technology Fee
+ 12% State Surcharge
Paid By
MATTHEW CLEMENT
Item Total:
Check N umber Authorization
Reeeived By Batch Number Number How Received
CJC
00561 B hi Person
Payment Total:
Page I of I
9:08:58AM
Amount Due
19.00
39.00
79,00
7,00
7.20
17,28
$168.48
An;lOunt Paid .
$168.48
$168.48
8/412009