HomeMy WebLinkAboutPermit Mechanical 2009-8-5
Mechanical Permit Application
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225 Fifth Street + Springfield, OR 97477 + PH(541)726-3753 + FAX(541)726,3689
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I Datef:ls70 7 I
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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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I 0 Residential I 0 Government I JE(Commercial I
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I Job site address: 2355"' OL.'IIvIP,C Sf I
I City: .sN~./(IIt; {;'(' 1M' I State:lOA. I ZIP: I
I Subdivision: Ii]03~oC\\ ,0 \ 001~no. I
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I Name: 'I, 'Z.~s. n. A W K
I Address: Po t?o)- 30
I City: (l,A~1I ~'-'-I {
I Phone:
I E-mail:
This installation is being made on property owned by me or a
member of my immediate family, and is exempt trom licensing
requirements under ORS 701.010,
I State: f)'R..
I Fax:
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Signature:
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I Business name: CL>tv._~ r:... / JCI-/R I
I Address: IbG S' :L~V("IIi, 't2b I
I City: b/GGN ~ I State:OIE:. I ZIP: Of7ofoz- I
I Phone:S'II-'ibf l{f,l../ I FaxSL/HM 610<1 I
I E-mail: Da~IE..CrJ.....Nll".>-.ln.. . RIZ- I
I CCB licensen~,: I too 7S I
I Print name: 1\,cH}E s'MG.;;
I Signanrre~ '= 5~f
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440-2545-) (1lI08/COM)
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I First Appliance 1 1 $79,00
lFurnace/burner including ducts an~ vents
I Up to lOOk BTU/hr, ;: 1 1
lOver lOOk BTU/hr.
1 Heaters/stoves/vents
I Unit heater
Wood/pellet/gas stove/flue I
, Repair/alter/add to heating appliance/
refrigeration unit or cooling system! "
absorption system
Evaporated cooler
Vent fan with. one duct/appliance ve~t I
Hood with exhaust and duct I '
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$
$17,00 1 $
$20,00 $
$17,00
$38.00
$
$
$58.00
$
$13,00 $
$9,00 $
, , $13,00 $'
$58,00 $
Floor furnace including vent
Gas piping
One to four outlets I I
Additional outlets (each) 1: .
Air-handling units, including ducts
Up to 10,000 CFM I I $11.00 I $
Over 10,000 CFM $20,00 $
Compressor/absorption system/heat pump
Up to 3 hp/lOOk BTU $17,00
Up to 15 hp/500k BTU $29,00
I Up to 30 hp/l,OOO BTU $43,00
I Up to 50 hp/l,750 BTU ',I $57,00
Over 50 hp/l,750 BTU $95,00
I Incinerators
I Domestic incinerator
$7,00 I $
$4,00 $
$
$
$
$
$
$
I Enter total valuation of IT!.ech~ical system
and installation costs $ :.l~ ~;!
I Enter fee based on valuation ofmecn~ical system, etc, I~? tJ1=
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I Reinspection $58,00 $ I
I Specially requested inspections (per hr.) $58,00 $ I
I Regulated equipment (unciassed) 1 $13.00 I $ 1
I Each additional inspection: (I) I I $58,00 $ I
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I (A) Enter subtotal of above fees (or e'pter set I
minimum fee of $ 79.00) . ~l $
I (B) Investigative ree (equal to [A]) $ 1
I (C) Enter 12%surcharge(.12x [A+B]) $$S~' I
I (D) Seismicfee, 1% (.01 x [A]) $ I
1 (E) Technnlogy Fee (5% of[A]) $ 'S ? Z-I
I TOTAL rees and surcharges (A through E): $ '71:!::J-,
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CITY OF SrKll'lul' IELD
,
Building/C?mbination Permit
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
"
PERMIT NO: GOM2009-0I132
ISSUED: 08/0512009
APPLIED: 08/05/2009
EXPIRES: ()2/0512010
VALUE: $ 2,500.00
"
Status
Iss u ed
SITE ADDRESS: 2355 OLYMPIC ST
ASSESSOR'S PARCEL NO,: 1703254101002
Springlield TYPE OF WORK: Mechanical Only
, ,
TYPE OF USE:
PROJECT DESCRIPTION: REPLACE GAS LINE
Owner: CITIZENS BANK
Address: PO BOX 30
CORVALLIS OR 97339
'!:':':;;:;-:;8;;-008-~ l,t(CONTRACTOR INFORMATION i
UO!lBO!IIjON IIl!I!ln uoBaJO "'Yl )01 Jeqwnu '
Contractor TYl!eeuoUC()utra'ctor'JN) 'Jejuao a41 BU!J/Bo License
Mechanical '~,<1,,~e~r;:(~<'iMM'j~)'f~lA4PA1R IN'e nOA '0600 110075
4PO) les eJe 8e,r1) eSOLI.1 "7,',; I BuifuDiNG:\'NFORMATlON I
IIl!Inn uoBaJO aYl IIq paldopB salol MOIIOj , ,
# of Units: OJ 11011 seJ!l1baJ MBI uoBaJO :N<tIIQ.N~!Q.!i!~s:
Primary Occupancy Group: Height of Structure
Secondary Occupancy Group: ' Type of Heat:
Primary Construction Type Water Type:
Secondary Construction Type: Range Type:" ,
# of Bedrooms: Energy Path:
Spriokled Building: n/a
NOTICE: , DEVELOPMENT INFORMATION I
THIS PERMIT SHALL EXPIRE IF THE'WORK
Frontyard Setback:\IJTHORIZED UNDER THIS PE9,y,~na~mT
S~de I Setback: COMMENCED OR IS ABANDO~I~tr",!i~j!{rees Rqd:
SIde 2 Setback: 'ANY 180 DAY PERIOD Paved ~nve Rqd:
Rearyard Setback: '% of Lot Coverage:
Solar Setbacks: '
I PUBLIC IMPROVEMENTS I
Commercial
i ~ '
Expiration Date
,
12/18/2009
Phone
541-461-4821
Lot Si~,e:
Sq Ft rst Floor:
Sq Ft 2,nd Floor:
Sq Ft l!asement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
I,
,: REQUIRED PARKING
!
Total:
. Handicapped:
, Compact:
Sidewalk Type: i
Street Improvements:
, Storm Sewer Available: .
Special I nstruction: ,
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Downspouts/Drains:
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Notes:
I Valuation Descrintion I
Descript~on
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Tvpe of Construction
Page I of 2
Value
I
Date Calculated
Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: GOM2009-01132
ISSUED: 08/0512009
APPLIED: 08/0512009
EXPIRES: 02/0512010
VALUE: $ 2,500.00
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Mechanical CIl Use Bid Amonnt
$1.00
2,500,00
$2,500,00
$2,500,00
08/05/2009
Total Value of Project
Fees Pair! I
Fee Description
+ 12% State Surcharge
+ 5% Technology Fee
Mechanical-Value
Amount Paid
Date Paid
j,
Receipt Number
$8,13
$3,39
$67.75
8/5/09
8/5/09
8/5/09
2200900000000000875
2200900000000000875
2200900000000000875
Total Amount Paid
$79,27
1
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. wiU:be made the following
kd ' \ I, '
wor ay. I
I Re{Jllir~r! I n,"ec~!ons I
Rough Gas: After line is installed and required testing and capped if not attached to an ap~liance,
Final Gas: When all gas 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 Springfield and the Laws of the State of Oregon pertaining to the wdrk described herein, and
that NO OCCUPANCY will be made of imy structure without permission of the Commu'nity Servi~es 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
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Owner or Contractors Signature,
0/\/0:;
Date
Pa2e 2 01'2
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2009-0 1132
COM2009-01132
COM2009-01132
Payments:
Type of Payment
CreditCard
cReceint I
RECEIPT #:
D~scription
Mechanical-Value
+ 5% Technology Fee
+ 12% State Surcharge
Paid By
DAVE BRAGG
City of Springfield Official Receipt
j'
Development Services Department
Public Works Department
"
2200900000000000875
Date: 08/05/2009
"
8:33:22AM
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
Amount Due
67,75
3,39
8,13
$79,27
Amount Paid
CJC
$79,27
$79,27
076562 In ~erson
Payment Total:
I;
Page 1 of 1
8/5/2009
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, : .' ,;=-uaen,e. Oreao~ 97402 '
, , 541.461-4821
CCB Number 11075
Scale: 118" : l'~O"
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ApprOved:
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