HomeMy WebLinkAboutPermit Mechanical 2009-8-18
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'''\.J~~hanical Permit Application
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I Permit nb: e'7'- 1197" I
I Date: ~ /1 ~/G) 7' I
This permit iS,issued under OAR 918-440-0050. Permits expire if work is uot started within 180 days of issuance or if work is
suspended for 180 days.
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I D Residential I D Government 1iQ] Commercial
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I Jobsiteaddress:,L-/7IA ,If), lIN/ ~at
I ~i~::6pVlvJjh€ld . LState: OJ2- I ZIP:Q1Ll-11
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"~~r3"'~~.~j:iR0f!ERm;Y~OWNERif.~""'~~-?;~.J1);~-!
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I Name L U, 'XIDIJ IHiaft'
I Address:.127C. UK-F.M.vr 'Drz...
I City: t:;U C7='Ivt-- I State: br?-
I Phone: -~ ot -1111 IJ I 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,
Signature:
1~!_'1(<f(;!fliiliMc;J~R.~[!i\~illK[lc'Aiti9]~~~1
I Business name:, ,r-fi I\,{ ~nll;/: fjII all I tnc. - I
I Address: 'lJuuiJ I{PYf,P: V2lvk.w1AA
city:Xwil1llkhdi!1 State: OIZ!.. I ZIP:t11417
~. IFax:--
I E-mail (;JlmJ - t-vnitleprYVlbfq:I.C6y()
I CCB license no,: -tl /)1[ ~ 11 () ..
I Print name: .IlJ2 ....;..-
I Signature: '/I
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225 Fifth Street. Springfield, OR 97477 . PH(541)726.3753. FAX(541)726-3689
I
I ZIP: "j';y{) C
440-2545-) (llIOS/COM)
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i;,;,.:,"\.~...~l~.'~,IJ__~l~~~s:~~;~~~_~~~l~~*f~~ 1t~211 ~~:r~"J1 .._.~o~cost~~
I First Appliance 'I $79,00 $ 1
\Furnaee/burner including ducts and vents
I Up to lOOk BTUIhr.
lOver lOOk BTUIhr.
1 Heaters/stoves/vents
I Unit heater
Wood/pellet/gas stove/flue
Repair/alter/add to heating appliance/
refngeration umt or cooling system!
absorption system
I Evaporated cooler
I Vent fan with one ductlappiiance vent
.~ Hood with exhaust and duct
f Floor furnace including vent
Gas piping .
lOne to four outlets I I
I Additional outlets (each) ,
'I Air-handling nnits, including ducts
I Up to 10,000 CFM I I
lOver 10,000 CFM
1 Comnressor/absorntion svstem/heat numn
I Up to 3 hpllOOk BTU I
I Up to 15 hp/500k BTU I
I Up to 30 hpll,OOO BTU
I Up to 50 hpll,750 BTU
lOver 50 hp/I,750 BTU
1 Incinerators
Domestic incinerator
I I
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$17,00 I $
$20,00 $
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1
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$17,00
$38,00
$
$
$58.00
$
$t3,OO $
$9,00 $
$13,00 $
$58,00, $
$7,00 I $
$4,00 $
$11,00 I $
$20.00 I $
$17,00 $
$29,00 $
$43,00 $
$57,00 $
$95.00 $
$
,I Enter total valuation of rnjchaniCal system
and installation costs $ -L...O 50 _" 6 D
Enter fee based.on valuation of mechanical system, etc. I $ )-0
trM""''''-->iff'iI'I'P'I'!:-f""i!ilI,llf.. .;;",ilil!lF..lc\,',f$~~q"".liI'lfIi"'EGost~I!li'i,1'otiill.;'
~ Isee aneOUS!, ees%\:- 1V:>llilli""<l,,>.\f;.,~it,;q~tems " ""-'~"""~ ~ - ,"",.' ,,",
i'!2:c€.1,,:"".%>~~1f;\~U;f':;,..,t!>lHIl.<&;.""~~_ "!i""Yl'if(;:,'B...;n; -Z1,,,~,'Illf!J , "*,,,,, ea~.,~ ~cost" .!
I Reinspection '$58,00 $ I
I Specially requested inspections (per hr.) $58.00 I $' I
I Regulaled equipment (unclassed) I $13,00 I $ I
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I (A) Enter subtotal of above fees (or enter set .-t
minimum fee of $ 79,00) $ 7 '1
I (B) Investigative fee (equal to [A]) $ I
I (C) Enter'12% surcharge (.12 x [MB]) $ <7 ~ I
I (D) Seismic fee, 1% (.01 x [A]) $ I
I (E) Technology Fee (5% offAl) , $ ') ~ I
I TOTAL fees and surcharges (A t,brough E): $ "11 t!-I
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FM Sheet Metal Inc.
COMMERCIAL HEATING and AIR cONDITIONING
SPECIALTY FABRICATION AND SERVICES
3000 Pierce Parkway Springfield, OR 97477
Phone (541) 726-3000 Fax (541) 726-HVAC (4822)
CC8 # 089710 WWW,fmsheetmetaLcom
PROPOSAL
TO:
A Better Way to Go
Attn: Susan Hammond
FROM: Jo~1 V Hutchinson
DATE:
August 13, 2009
PROJECT:
Exhaust Modifications
FM Sheet Motallnc, proposes the follo\ving:
Disconnect existing vertical duct work from existing S/S hood.
Raise existing hood to a height determined by owner.
Fabricate and install one end cap over remaining opening of duct work,
Fabricate approximately 6ft if 6" S)S round pipe from 24 gauge material
and i[).Stall between new piece of equipment and the bottom of existing duct.
Re-support duct worl<.
~ Price for above as ctcscribed____m___n_____-----m-m---.--n....-m----.--m.-m-m-.m-----.$1,050.00
.-
Exclusions: Roofing; electrical; Patching; Painting; Framing of openings; Carpentry; demolition, Plumbing; Ceiling removal or
replacement; Hazardous material abatement; Permits or fees; Bonds.
~
All material is guaranteed to be as specified, All work to be completed In a workmanlike manner according 10 standard practices, Any
alteration or deviation from above speCiiications Involving extra costs will be executed only upon written 0 s,and will become an
extra charge over and above the estimate, All agreements conti ent upon strikes, accidenls or delays eja d our control, Owner to
carry fire, tornado and other necessary insurance, Our workers fully covered by Work en's C nsati n Insurance, 1 YR,
LABOR & MATERIAL GUARANTEE, Price Is good for 30 days, n \' - '
AUTHORIZED SIGNATUR.J(; . --" / ,
,,/'
~
ACCEPTANCE OF PROPOSAL
1'he above prices, specifications and conditions are satisfactory and are hereby, accepted. You are authorized to do the
work as specified, Payment will be made as outlined above,
ACCEPTED DATE:
, SIGNATURE:
. '
cd
S9LSON
JNI 1~13~133HS ~j
~dElcl 600c 'EI '8n~
Status
Iss u ed
CITY OF SPRIN'-TJ:<lJ:<,LD
Building/Combination Permit
PERMIT NO: COM2009-01194
ISSUED: 08/1812009
APPLIED: 08/1812009
EXPIRES: 02/18/2010
VALUE: ' $1,050~00
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 471 S A St
ASSESSOR'S PARCEL NO.: 1703353113300
Springfield TYPE OF WORK: Mechanical Only
Owner:
Address:
TYPE OF USE:
PROJECT DESCRIPTION: Adding rottisserie vent, altering hood and duct
ATTENTION: OreGon 'RW rpmd,oo "~,,._
, IUIIOW rUles adopted by the 0 - Ut'/'
SW AGGART LESTER G'& M.A regon Ilty
3276 LAKE MONT DR :~-,.,.~~,,~n Center, Those rules are set forth
EUGENE OR 97408 In OAR 952-001-0010 through OAR 952-001-
0090, You may obtain cOOles of thp "doo h"
"""II1Y "'8 cenrer. (Note: the tAlcmhnnp -
number ICC0NTRACTORiINF.0RMATION I
""'Cllll;;;l I'=! t-OUu-vv;:::~;:::;j44).
Contractor' License
FM SHEET METAL INC 89710
Commercial
Contractor Type
Mechanical
Expiration Date
03/15/2011
Phone
54 I - 726-3000
BUILDING INFORMATION I
# of Units: # of Stories:
Primary Occupancy Group: A2 Height of Structure
Secondary Occupancy Group: NOTICE' Type of Heat:
Primary Construction Type TH . Water Type:
Secondary Construction Type: IS PERMIT SHAR'a.[g'<ff'tiypidF THE WORK
# of Bedrooms: AUTHORIZED UNDEliefi:)l$'lft!!:;lMIT IS NOT
,~~,~~~E~N~~.D 9_R l~p,r\il}J<.\~V~?jl'\!J'pbR Yes
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other: '
,
Occupant Load:
'V'V I....... . . n..., I
I DEVELOPMENT INFORMATION I
REQUIRED PARKING
Frontyard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
0/0 of Lot Coverage:
Total:
Handicapped:
1 Compact:
I PUBLIC IMPROVEMENTS I '
Street Improvements:
Storm Sewer Available:
Special Instruction:
Sidewalk Type:
DownspoutslDrai'ns:
Notes:
I. Valuation DescriDtion I
Description
Type of Construction
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value.
Date Calculated
Paee I of2
Status
Issued
CITY OF ~rKll~GFIELD
Building/Combination Permit
PERMIT NO: COM2009-01194
ISSUED: 08/18/2009
APPLIED: 08/18/2009
EXPIRES: Oi/18/2010
VALUE: $ 1,050.00
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Mechanical C/I Use Bid Amount
$1.00
1,050.00
$1,05,0.00
$1,050.00
08/18/2009
Total Value of Project
Fees ~~id I
Fee Descrintion
+ 12% State Surcharge
+ 5% Technology Fee
Mechanical-Value
Minimum/Adjustment Mechanical
Amount Paid
Date Paid
Receipt Number
$9.48
$3.95
$58.00
$21.00
8/18/09
8/18/09
8/18/09
8/18/09
2200900000000000924
2200900000000000924
2200900000000000924
2200900000000000924
Total Amount Paid
$92.43
Plan Reviews I
, To Request an inspection call the 24 hour recording at 726-3769. All inspections r~quested 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 Reouired Insnections I
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 l'urther certify that any and all work performed shall:be done in accordance with
the Ordinances ofthe City of Springtield 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 d~ring construction.
~~4UU'~/rP 3pg/iM
Owner or.Contractors Signature
Date
Paee 2 of 2
225 Fifth Street
Springfi;id, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2009-0 1194
COM2009-01194
COM2009-0 1194
COM2009-0 1194
Payments:
Type of Payment
Check
cReceintl
RECEIPT #:
City of Springfield Official Receipt
Development Services Department
Pu~lic Works Department
2200900000000000924
9:30:28AM
Date: 08/18/2009
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
cjc 1714 In Person
Payment Total:
Amount Due
58.00
21.00
3,95
9.48
,$92.43
Description
Mechanical-Value
Minimum! Adjustment Mechanical
+ 5% Technology Fee
+ 12% State Surcharge
Paid By
SUSAN COX-HAMMOND
Amount Patd
$92.43
$92.43
, /
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8/18/2009