Loading...
HomeMy WebLinkAboutPermit Mechanical 2009-8-24 Mec.ha'nical Permit Application 9 ~'1DEOpftRTMENiT1ClSEToNi!:y;,~;1} ~J'::;"F"-!::!,~''''!'I:''7:':''t<r;~J'''_3H.~,;;W!:''~~,r.~: Permit nol9 I Z)4- I Date: Mh'/}p 225 Fifth Street t Springfield, OR 97477 tPH(541)726-3753 t FAX(541)726-3689 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. 1(...~('u.cAillg9.9BYlQfk,Cofi~mFfQ9J~QN~~~1 I D Residential I D Governmeut I E:!-Commercial I 1[~~j.9!3]~m~~@F,qBM~1ijIQNf~~pl@j~G~illj@~{}~F~11 I Job site address: ..-\/1 A '7h 1'/,a;; A Shy/)--- . I CitySpY'I/1 A[J lIt! I State: bJ( I ZIP: q1417 I Subdivision7l'100 ~'?>t 1 Lot no.:l~~ Ijli""-';;;''J!~'r'':':~5ESCRfE,tIONf:5~WORK~"'P''''~~ . . .~,-.,~_,j1~~. .'_..._. ,> .~-'.---". .__ .......~_. ,_~_ ._.. ,.__'--._-'"~_.._ - ."_,,,,,_~,_ >-;:N;J b~~-ffi ~~A' ~;m1 /:'ZbtJlJlI:r; hJ 1 hl-d,tvt rQ'iJ~~VIe. 111 kl .hen O:/1tl1r- ~71;i1['f.;;'I:~NJlil~1\liijBOI?J~.Bl';'i'~&Wfl~~1'-.1i'~r.:llR~.~~ Name: 1 (J L, '5l1A j/1/~i7J IC I I Address: '.' I I I City: I State: I ZIP: I I Phone: I Fax: I I E-mail: I 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. (~gnature:.. ... . . ..... ...... . I 1liJ!"j~~lv:5;d~ONm.i3A'"giIQR.ljr~i~Ijj~li!,tAf:iQ}l.';~f'tf~_~~ ! I Business name: 4,!,.;t~)Zi. 7~Y V~ (OL t1.p) I i Addres.~ r () 0N '7617;1' !, I i City:Vt HpI/)P. I State: t>i2- I ZIP: '17 I i I Phone:. L' ~f - I Fax: I ! I E-mail: I \ I CCB license no.: I i i I Print name: I \ \ I Signature: I \ ~/Ui-(~.I;f...4fi1f/f7"yP' , ~S'ivlSft~ C. 'Hl'V"A/l/INj)7 .-h~""'" US ~,/V2t11art .~~# ~~, ~l ~f'tr &.d^ ro~~ ~Ij\ 440-2545-) (11/08/COM) ,"''!'''''!I>'''''',,'!\fiim_'I'<,I.r ---,,' "u'--'-"_"''''~"'~___>l'!*'11 1~,,!:~{i1i'~,-,,~~!iFF.>I!S9.l:l.E:.QJ:J~!;:~~~~,~,&:~ ~R'9<;~':::"~'~t~'t'lJl'R.. ;;'~"1-:':;.,'"'~.: _:e~;tJ{.j,f~~I'Q~:~Xf;-;I"':\1ll~~cost~;': 1:~Total~~1 )~ . eSluen 13 ,\;1'. ~ ,~..,;.:r~}~.. "~..\l1-':~~F"" ty:: ~..; . <-'-~~""i;; \ "3l~, -..;,.~ :~it -'1't't'd_'......'.~,.-.,"'~_;~. .,~~~,~,,;4i<. '4:I-",~ ~:r:.':'~..u,,;;m .\.,.'.:.i!oj ,/fti-,- $.ea.,~'1"". ~'BJ,coshr:\,., I First Appliance $79.00 I $ I lFurnace/burner including ducts and vents I I Up to lOOk BTUlhr. I I $17.00 I $ I lOver lOOk BTUlhr. $20,00 $ I I Heaters/stoves/vents I I Unit heater $17.00 $ I . Wood/pellet/gas stove/flue $38.00 $ I Repair/alter/add to heating appliance/ I refrigeration unit or cooling system! $58.00 $ absorption system I Evaporated cooler $13.00 $ I Vent fan with one duct/appliance verit $9.00 $ I I Hood with exhaust and duct $13.00 $ I I Floor furnace including vent $58.00 $ I Gas piping I lOne to four outlets I I $7,00 I $ I I Additional 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 to 15 hp/500k BTU $29.00 $ I I Up to 30 hpll,OOO BTU $43.00 $ I I Up to 50 hpll.750 BTU $57.00 $ 1 lOver 50 hpll,750 BTU $95.00 $ I I Incinerators I IC"CD~::::~::~:'~~I~:'~<"l%'F31.i'lt'''''''''1I",J.","J~S:~:~~~;)1\$'i4i'i'""'''II ~,.... ,om.rn..~r:~!~J~:ff.;:1l~1k~rril:VM'J~.Sf';_.;:t~$~~~~~~~2r;~i I Enter total valuation of mechanical system I' and installation costs $ ~O Enter fee based on valuation of mechanical system, etc, I $~,.fvtJV rM-'<;:@Ti''''''''''''!'.!!lif''''''ffif''''l11!it~'lj'il.'$'I-.''''4'Iil<f~S'ost':l!!l'!!!l.1'Otal~.' I ~~~~S^~~?~~~~'r~~~it~~~i~~l*,,~~ ~_~ea!f.s'~ f}~cost~~ Reinspection I $58.00 $ I I Specially requested inspections (per hr.) I $58.00 $ I I Regulated equipment (unclassed) I $13.00 $ I I EaC.Chh.~~~:~::-'.~in.. s:~~~~~.:,.< ~),... ','1.._. L. .C\l.''','1&~. ,O~"'~_-'i1m~11 _~~~__"ARP.l.'.IC::Af\liI:",l:JSE'ill&!"""fii!m_!;1,~Rb!! I (A) Enter subtotal of above fees (or enter set I I minimum fee of $ 79.00) $ I (B) Investigative fee (equal to [A]) I $ I I (C) Enter 12% surcharge (.12 x [A+B]) I $ I I (D) Seismic fee, 1% (.01 x [A]) $ I I (E) Technology Fee (5% of [A]) $ I I TOTAL fees and surcharges (A through E): $ I CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO:COM2009-01234 ISSUED: 08/24/2009 APPLIED: 08/24/2009 EXPIRES: 02/24/2010 VALUE: $1;000.00 -~!j!:I'ij~'.i!I!!!!,'.~.. ~W,:'.i'~";J ". ,'-'t! Status Issued 225 Fifth Street, Springfield, OR 541.726.3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line SITE ADDRESS: 471 SA St ASSESSOR'S PARCEL NO.: 1703353113300 Springlield TYPE OF WORK: Restaurant TYPEOF USE: Alteration Commercial PROJECT DESCRIPTION: EXTENDfNG GAS PIPING TO KITCHEN. RECORD INSPECTIONS ON C9.1194 Owner: SW AGGART LESTER C & M A Address: 3276 LAKE MONT DR EUGENE OR 97408 CQntractQr Type Mechanical I CONTRACTOR INFORMATION II ATTENTION: ~,~"v" ._.. .~~_...__ ,Co" C t'^"'t'" 'ules adopted by the Oregon Utili"'/. Qn rac Qr Dlcense r-.'G;faj...."t',..,,., ("Clntar Thn.se rules are set fOlll J AMB~~~~P'QR np'IN~ .I,~.~ '" ,,,h nAI'< Q<;?nrPJ469 0090. You mall CBUIUDING'INFORMWTION. calling the Cblltc.. \1~Vi.'...... '"'''' ,...,'-"1"'''_..- number for the OrF#)orStU~i~~:Notification C t . 1- oqq. ""';S:J <.r:i44) en er IS Height of Struct'ure Type of Heat: Water Type: Range Type: Energy Path: Sprinkled Building.. # of Units: Primary Occupancy Group: Secondary Occupancy Group: Primary Construction Type Secondary Construction' Type: # of Bedrooms: Frontyard Setback: Side I Setback: Side 2 Setback: Rearyard Setback: Solar Setbacks: I DEVELOPMENT INFORMATION I NOTICE:' , THIS PERMIT SHAL6EX~IRb.lF.THE WORK AUTHORIZED UNDE" "eM?' u~s~MIT 'S NOT # Street Trees Rqd: C 0 OR Ie ^ 0 ^,'r'I(,\~lrn '-OR COMMEN E ~PavedIDr;veRqd: ANY 180 DAY PERIC?7.J.ofLot Coverage: I PUBLIC I~~ROV~MENTSI ExpiratiQn Date 03/27/2011 PhQne 541-726-5723 n/a Lot Size: Sq Ft 1st Floor: Sq Ft 2nd Floor: Sq Ft B,asement:. Sq Ft Garage/Carport Sq Ft Other: Occupant Load: REQUIRED PARKING Total: , Handicapped: Compact: Street Improvements: Storm Sewer Available: Special Instruction: Sidewalk Type: Downspouts/Drains: Notes: I ValuatfQ~ Des~riDtion, I Description $ Per Sq Ft, or multiplier . Square Footage or Bid Amount Type of Construction Paee I of2 , Value Date Calculated Status Issued CITY OF SPRINGFIELD Building/Combination Permit PERMIT NO: COM2009.01234 ISSUED: 08/24/2009 APPLIED: 08/24/2009 EXPIRES: 02/24/2010 VALUE: $2,000.00 225 Fifth Street, Spriugfield, OR 541-726-3753 Phone 541-726-3676 Fax 541-726-3769 Inspection Line Total Value of Project Fees Paid I .1"(' i Fee Description + 12% State Surcharge + 5% Technology Fee Mechanical. Value Amount Paid Date Paid $6.96 $2.90 $58.00 8/24/09 8/24/09 8/24/09 Receipt Number 2200900000000000951 2200900000000000951 2200900000000000951 Total Amount Paid $67.86 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 Reouired l'lsnections I " 111111 r 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 shalfbe done in accordance with the Ordinances of-the City of Springlield 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 Servkes 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. ~u/2//~ /,:;n k'dV~e7~ 14/~/{J~) I . Owner or Contractors Signature Date Page 2 01'2 225 Fifth Str.cet Springfield, Oregon 97477 541-726-3759 Phonc..... _"_nnu_ Job/Journal Number COM2009.01234 COM2009-01234 COM2009-0 1234 Payments: Type of Payment Check cReceintl RECEIPT #: Description Mechanical.Value + 5% Technology Fee + 12% State Surcharge Paid By HORIZON HEALTH SVCS ~iEjIJ.. .. City of Springfield Official Receipt Development Services Department Public Works Department 2200900000000000951 Date: 08/24/2009 Item Total: Check Number Authorization Received By Batch Number Number How Received CJC 583 In Person Payment Total: Page I of I 8:40:44AM Amount Due 58.00 2.90 6.96 $67.86 Amount Paid $67,86 $67.86 8/24/2009