HomeMy WebLinkAboutPermit Mechanical 2009-8-24
Mec.ha'nical Permit Application
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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.
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I D Residential I D Governmeut I E:!-Commercial I
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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''''~~ .
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hl-d,tvt rQ'iJ~~VIe. 111 kl .hen O:/1tl1r-
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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:.. ... . . ..... ...... .
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! 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
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i I Print name: I
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\ I Signature: I
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440-2545-) (11/08/COM)
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~R'9<;~':::"~'~t~'t'lJl'R.. ;;'~"1-:':;.,'"'~.: _:e~;tJ{.j,f~~I'Q~:~Xf;-;I"':\1ll~~cost~;': 1:~Total~~1
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-'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
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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
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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
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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.
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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