HomeMy WebLinkAboutPermit Mechanical 2009-9-4
Mechanical Permit Application
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I Pennit nL (l7 -;) /2 I
I Date: 0; / if 10 '7 I
225 Fifth Street. Springfield, OR 97477 . PH(541)726-3753 . FAX(54 1)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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D Residential 1 D Government lli Commercial 1
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I'Job sit~ address '2,1w ~VlUvt- -glllc./.., 1
1 City: ~ 1 State: oL I ZIP: 0(140'3, 1
~Ubdivision: . ,I Lot no.: . _
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1 Name: ,::: (<. ('-'-co..... ~ (N oj 1
I Address: f'"D <&, l<' '7 , L{ I
I City: 5PFL--b 1 State:tV"--1 ZIP: 1
I Phone: I Fax: I
I E-mail: 1
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 791.010. '
Signature:
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1 Business name: nvvdlj<t,) 1
I Address: 180 l (../wi q ~ JJ 1
1 City: '..~w-L---- J 1 State: 'li_((,. . 1 ZIP: <11..foL I
1 Phone:I,i/I.{,9i- Bts(, 1 Faxof/ -6If1- fJit/4 I.
I E-mail: I
I CCB license,no.: 101 )...N I
I printname:Sheev. .f.h~~ I
1 Signature: ~~ I.
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440-2545-1 (llI08iCOM)
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~.-R""'~""~t,\,f,i'I,,,1!T,t~- .(l1!t'l'. '.:I""'''';'~~'''',r,".<';;-lh.'':'fr.Q'''Il~I''~Cost'''''' -'I!IJi\Total"'.lA
;J - eSluen la !.;t~~""_ J)~iu~~i" ~"'!;\\,1<cr'JH::' ty;: ~~"'M~' '. - ,'c......"t'3~,
':;;;;~~;;;:::~'q:if~~/~;;J-.,...t'I;~;9~~"~ "$7s,;-" I
!Furnace/burner iocli-ding ducts and vents I
I Up to lOOk BTU/hr. I $17.00 I $ I
lOver lOOk BTUlhr. I $20.00 $ I
I Heaters/stoves/vents I
I Unit heater $17.00 $ I
I Wood/pellet/gas stovelflue $38.00 $ I
I R. epair/alter/acl.d to heating applianc'el I
refrigeration unit or cooling system/ :; $58.00 $
absorption system
I Evaporated coole, $13.00 $ I
\ Vent fan with one duct/appliance verit $9.00 $ 1
I Hood with exhaust and duct $13.00 $ I
I Floor furnace including vent $58.00 $ )
I Gas piping I
lOne to fou, outlets . I $7.00 I $ I
I Additional outlets (each) I $4.00 I $ I
I Air-handling units, including ducts I
I Up to 10,000 CFM I I $11.00 I $ I
Over 10,000 CFM . $20.00 $ I
I Compressor/absorption svstem/heatpump I
I Up to 3 hpllOOk BTU $17.00 I $ I
I Up to 15 hp/500k BTU $29.00 $ I
I Up to 3.0 hpll,OOO BTU $43.00 I $ I
I Up to 50 hpll.750 BTU $57.00 $ I
lOve, 50 hpll,750 BTU $95.00 I $ I
I Incinerators I
Domestic incinerator - $ , I
I
Enter fee based on valuation of mechanical system, etc. I $ I .
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Reinspection I $58.00 I $ I
I Specially requested inspections (pe, hr.) I. $58.00 $ I
I Regulated equipment (unclassed) I I $13.00 I $ I
Each additional inspection: (1) I $58.00 $ I
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(A) Entersubtotal of abo,dees (0' ente, set '1'1' I
minimum fee of $ 79.00) $ - {
I (B) Investigative fee (equal to [A]) $ ~
I (C) Enle, 12% surcharge (.12 x [A+B]) $ 0"16 I
I (D) Seismic fee, 1% (.01 x [A]) $ I
I (E) Technology Fee (5% of [A]) $ :3:z.:[ I
1 TOTAL fees and surcharges (A through E): $ 92 V 1
Enter total valuation of mechanical system
and installation costs $ ..5J2o
Status
Iss u ed
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-01312
ISSUED: 09/04/2009
APPLIED: 09/04/2009
EXPIRES: 03/04/2010
VALUE: $2,000.00
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 3400 FRANKLIN BLVD
ASSESSOR'S PARCEL NO,: 1703343200100
Eugene
TYPE OF WORK: Mechanical Only
TYPE OF USE: New
Commercial
PROJECT DESCRIPTION: ADD GAS LINE
Owner:
. Address:
Contractor Type
Mechanical
SKILLERN INVESTMENOTS LIMITED-I!ARTNEbu to
PO BOX 714ATTENTIUN: rel-JulI ,,," ",",U" W , Utilit
SPRINGFIEUi)Y0R;.I'9747TopteTdhbY th~I~~ea~~~et 10r1h
"I~h.;,,...,,tlf.,n ~Antp.r. ose I _ .
in OAR 952-001-0010 througn Ur-\n ~"G.-v,":'
0090, You may obtaihC0N1'RAGTOR''1NFORMATION I
calling the center. \'" UlI> , "'0 '~'~r:"-'.'-
Gontr.actOlthe Oregon Utility Notr1rcalion
FERR~UG~S'!LP-800-332-2344) ,
License
101244
Expiration Date
OS/23/2010
Phone
541-688-8155
I. BUILDING INFORMATION I
# of Units: # of Stories:
Primary Occupancy Group: Height of Structure
Secondary Occupancy Group: Type of Heat:
Primary Construction Type Water Type:
Secondary Construction ;r,y\X):'CE' Range Type:
# of Bedrooms: I~v I i ER'MIT SHALL EX,El1f1:~I'[~t,l!:: WORK
. THIS P Sgrinkled nuildingT n/a
^rrTWf1PI7i=n IINnER THI t"cnlVlIl IV"
COMMENCED UIIDivEUOPM:ENi-iNFORMATlON ,
AtN 180 DAY PE:nruLJ. '
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
Lot Size:
Sq Ft 1St Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other: .
Occupant Load:
Frontyard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
REQUIRED PARKING
. Total:
Handicapped:
.. Compact:
I PU~LIC IM:ROV~MENTS I
Street Improvements:
Storm Sewer Available:
Special Instruction:
Sidewalk Type:
DownspoutsfDrains:
Notes:
I Valuation Descriotion I
Description
Type of Construction
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Paee I Of 2
Cln; OFSrKll"GFIELD
,
Status
Issued
Building/Combination Permit
PERMIT NO: COM2009-01312
ISSUED: 09/0412009
APPLIED: 09/04/2009
EXPIRES: 03/04/2010
VALUE: $ 2,000,00
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Total Value of Project
Fees Paid I
Fee Description
+ 12% State Surcharge
+ 5% Technology Fee
1st Appliance
Amount Paid
Date Paid
Receipt Number
$9.48
$3,95
$79,00
9/4/09
9/4/09
9/4/09
1200900000000001029
1200900000000001029
1200900000000001029
,
Total Amount Paid
$92.43
I 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 Relluired lnsnections I
rr ,
Rougb Gas: After line is installed and required testing and capped if not attached to an ap~Hance,
Gas Service: After line is installed and line has been connected to a minimum of one applia*ce including required
testing. Presure test done at this point.
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 1 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 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 wm;'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 c, rd is located at the front of the property, and the approved set of plans will remain on the site at all
times:r=til.' 7' J'--IJOC(
'-
Date
Paee 2 of 2
225 Fifth Street
Spl:ingfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2009-0 1312
COM2009-0 1312
COM2009-01312
Payments:
Type of Payment
C,editCard
cRcceint I
RECEIPT #:
Description
1st Appliance
+ 5% Technology Fee
+ 12% State Surcharge
Paid By
JADE FRENCH
-Z~~2~
..:
City of Springfield Official Receipt
Development Services Department
Public Works Department
1200900000000001029
1O:01:18AM
Date: 09/04/2009
Item Total:
Check Number Authorization
Received By Batch Number Number How:Received
CJC 020 I OlIn Pe,son
Payment Total:
Amount Due
79.00
3.95
9..48
$92.43
Amount Paid
$92,43
$92.43
Page] of I
9/4/2009