HomeMy WebLinkAboutPermit Mechanical 2009-9-16
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Mechanical Permit Appli~ation
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225 Fifth Street. Springfield, OR 97477 . PH(541)726-3753 . FAX(541)726-3689
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This permit is issued under OAR 918-440-0050. Permits expire if work is Dot started within 180 days of issuance or if work is
suspended for 180 days.
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1 0 Residential \ 0 Government 1111 Commercial I
I'J'V~;tOB1SI:ri: 'INI;,QRMATI(jNf",ND):toCAJ'16N"~;:i1;,1
I Job site address: 11f1J') ,,~~t. I
I C. 0, I I :i) I q.1 I UptoIOOkBTU)hr.
City: ')1lvir1Q n'tl~' State: V.... ZIP: 1"'T 11
I I . U .., / I lover lOOk BTU/hr.
Subdivision: 170s voi.{Z Lot no.: OIl-Of
_ I~""~'-"~ri "'.-'- '. ,- .,---" ----, ---'\1',-..,..'",: ~f--'I:;:~"NffliI- Heaters/stoves/vents
~~~X,,,,~~A:~;:I'!rH:-,1{Q_ES.c::~J~JIQ~sQF;iW9~"S1jt;,j',]t2r~ f;.;i::,~, I Unit heater,
~lt.I-t qi~fir1.~ 1S b., r,lk!MaJll kw.t~\iVlr(i-:t 1 Wood/pelletlgasstovelflue
~i,~~~'~~,Yi c':'\V~Y'l.mA, .", i~,), I iVl, b, ~U r1,~'!' JfP~ jl.~i~ ,~~ffi~;~~,~\~~,a~~, itt~;'~~~~~:~r;:::/e/
~\~.~_!J'~'s:":l~U-j;!2,~ki.~R~OP.E~D'JJ')_Wt-:J E~t'}1fb~~~4:' \t(~~:r. )~ N ~.~~~WIlJsYStha
I Name: (' i~ ~ ~Y1'n'\' \'d&TPlil&IW?~.I~~~'h~ trck:,.,.'y,"..:;~'d~i!N, .
I Add .... I 'c 'OJ () aTlofo\'Of!.h"v~---' Tho"elV!'<;Jltflln'WltIlWj.~uct/apphancevent
, ress, ~ ,'"OVT\\.... l) - . _ .rt..~.....tlf'ln C:enter. ,I -, n,'\I..j l--!:-1"';-UV .
I . ( , D . I I lw...'.~-" ,~~\1Ull ~Jq:tooo.wllnex!'~~sh~pd ducl
City: 'IIVlVlj 0"" c:L . State: ,;O/a./I,R 'p'ZlP,' "{: .~ lplEillo'ci} fu\'iia'"",v-~ct';n vent
I Phone \ -,'1/,,- 61./5'1 I Fa,oOgO~1'X~.::'1l/t.i:r '(N lte:@.~;~ii\i:~~~M g
I E-mail _~~.'.':~;;r';~~ the Oreg? 1 ~l~~~~p;lRfouilets I I
This installation is being made on prop~rty oWJ\edro.y;rrr\~ 6ro~' h.. .JA":dart'ional outlets (each) , '
member of my immediate family, and is exempt from licensing Air-handlin~ units, includin~ ducts
requirements underORS 701.010. Up to 10,000CFM , II $11,00 I $
1J:~~~l~i'~~~T~~~~~~~t~~~~t~~~~ ~::~;~~sOo~;'~sorPtion svstem/heat pump $20,00 $
I B. , (I \) 'f! !-h. L," Upt03hp/100kBTU $17,00 $
usmess name: lO\'V\Tl)rt'"" , filA) JI.(..GL1-t~
I "- .' \.. n' l'. \) Up to 15 hp/500k BTU $29.00 $
Address: 1:7))1, DllI\ <'1., JV''t<.-v Upt030hp/',000BTU $43.00 $
I CIty: 'fVl ~ fll-t ld I State: [)fl.... I ZIP,tfHll Up to 50 hp/I,750 BTU $57,00 1 $ I
I Phone: ''1"UrDIOO I Fax: -q9J9,~q'1bZ1 Over50hp/l,750BTU $95,001$ I
I E-mail: M.t1AVl~ ~ Lllll-"f>4f:la.w < (llvtA...- Incinerators'
I V "J 0 DomestIC mcmerator 1 I $20.00 1 $ . 1
i ::'.:a:~::se~~I,~~o~ "Ollct"" '\~ IJ~;::~~~~~G;~:~~,;;,:s~\(gWE~;:1
ItJ& -'" . (,';',~.- ~ptt)~~ b\.:rt~Jl-"'~f'Iil'~;;;'hamcal system, etc $ j
"i\-\I'S r II"\,; '~""'"'~f,o.''''\~V:~f~'''<:''f,:-,>w''~:'''I''<~''' ~";C::ost,~,, '~Total""
1''-'0\\ ,~ ~ &C;1i01aneous ee5"",-. ,,~,-;-l'~~ Items ;;:"> - ..;t- ~.!f ~ .t.,.
~llo~~c~Cct ~;~M;;" " ""-' ",,,-" .",..-, ,,>.~, .,,~~':: :$ cost''''1
p..W( ~ \\0 Df{pecJaIlY requested mspectlOns (per hr) $58.00 $ 1
1 Regulated eqUlpment,(unclassed) $13.00 $ 1
1 Each additional inspection: (I) $58.00 $ 1
f;~~J:;':~~'~~~A"P,P'12iCANj?~(j.S-El~~""?5k~;~~~;;if:~t~1 :
(~) ~nter subtotal ofabrive fees (or enter set ICI1-
mlnJnlUm fee of $ 79.00) _ f ( $,j
1 (B) Investigative fee (equal to [AJ) .-I-I-f1t( $:'
1 (C) Enter 12,% surcharge (.12 x [A+BJ) 'Jblf $ __u.
I (D) SeismiCfee, 1%(.01 x [AJ) $
1 (E) Technology Fee (5% of [AJ) 85 $ , , I
I TOTAL fe,es and surcharges (A through E): I $ ,"II )<14 i
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440.2545.J (ll/OS/COM)
I,....".: .,=,,",.,;' ,'.J;. ~,.~.<,j\"''''''''-'~~'':I "'"'I" . C::mf' ;'1' 'Total"1
~~e~lq~!'!tlaJi~t.'~fl'1l..~ >~!:~ :'J\"~1!f.. ~Qty.'< :\I::'.--,-(r'" ,:;". " ,,:'~
I ~F~~~;;p~I'i~~~e-"' ,. ,\~.l.~,.,..~,,__~., t- \io~' ._" ;r$7""9~~O""' ~ _.'S,eDst . "'1
lFurnace/burner including ducts and vents I
1
I
I
I
I I
$17.00 I $
$20.00 $
$17.00
$38.00
$
$' .
$58.00
$
$13.00 $
$9,00 $
$13.00 1 $
$58.00 1 $
$7,00 I $
$4.00 S .
v'"
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-01369
ISSUED: 09/25/2009
APPLIED: 09/1612009
. EXPIRES: 03/2512010
VALUE: $ 5,210,00
SITE ADDRESS: 1475 5TH ST
ASSESSOR'S PARCEL NO.: 1703264201201
Springfield TYPE OF WORK: Heating System
TYPE OF USE: New
Public
PROJECT DESCRIPTION: Heat pump
Owner:
Address:
CITY OF SPRINGFIELD
CITY HALL
SPRINGFIELD OR 97477
Contractor Type
Mechanical
fCONTRACTOR I~FORMATION 1
Contractor
COMFORT FLOW HEATING CO.
License
460
Expiration Date
06/27/2011
Phone
541-726-0100
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
Frontyard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Street Improvements:
Storm Sewer Available:
Special Instruction:
Notes:
Description
I BUILDING !N~ORMATlON I
# ofStori~~\J\(eS ~Ol\ t~
Heighl'ofStructureUt\\\ ~
o~eIILJ' . .,-,.." V\V~- t'o~\\l
-<,-,,-<\ON', > Typ'e'ofHeat: ale se 00'
,:\,<0'" cloP'." 'n\l~O "2 ,-
I" IU\PS a Water:'Typ.e:OF>-1'I g" - p~
10\\o'I'J , ; Ce11leka'n'e\t"'\~\ I\le IU\eS
N '1IIcal\o 01-0v ' - g ~pp~ 01 \lOne
. 9' p...'i' 952-0 ^ o~!'.ergY.'P~th,he te\e'p 11011
\n 0 "u rn"~ S . 'j{j")rB 'ld.'^'\t\Ca n/a
0090,.'~ ~he cer,,~~~nl'1n~ Ul\I!,I.;.~~~\.
G(;l.\"'-" ..,..~ ~ .- ~.~ ~~ -
nurnP'IlDEVEL0RJ\oIl"" ",FORMATION I
~-
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
REQUIRED PARKING
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
Total:
Handicapped:
Compact:
I PUBLIC IMPROVEMENTS 1 .
Sidewalk Type:
NOTICE:
THIS PERMIT SHALL EXPIR!cl~r'f~(>1lIW@l(ins:
AUTHORIZED UNDER THIS PERMIT IS NOT
COMMENCED OR IS ABANDONED FOR
ANY 180 DAY PERIOD.
I V~luation Descriotion I
$ PerSq Ft
or multiplier
Square Footage
or Bid Amount
Type of Construction
Value
Date Calculated
Pae:e lof2
Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-01369
ISSUED: 09/25/2009
APPLIED: 09/16/2009
EXPIRES: 03/25/2010
VALUE: $ 5,210,00
.
225 Fifth Street, Springfield, OR
541-726-375JPhone
541-726-3676 Fax
541-726-3769 Inspection Line
Total Value of Project
Fees Pairl.
Fee Description
+ 12% State Surcharge
+ 5% Technology Fee
Mechanical-Value
Amount Paid
Date Paid
$11.64
$4.85
$97.00
9/25/09
9/25/09
9/25/09
Receipt Number
2200900000000001096
2200900000000001096
2200900000000001096
Total Amount Paid
$113.49
Plan Reviews ,
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,
Hellllirerl I nsnections 1
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 further certify that any and all work performed shall be done in accordance witb
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 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 readabh:' 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
ti::::;~t;;ti;% SI~WY~t'~ 9~~~'1
(' , . /c..-;/(.)
Owner or Contractors SIgnature c>-- At' f Date
-~
Pa2e 2 of2
2~5 FinhS!reeL____
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2009-01369
COM2009-0 1369
COM2009:0 1369
Payments:
Type of Payment
Check
cReceintl
RECEIPT #:
Description
Mechanical-Value
+ 5% Technology Fee
+ 12% State Surcharge
Paid By
COMFORT FLOW HEATING
}
City of Springfield Official Receipt
Development Services Department
Public Works Department
2200900000000001096
Date: 09/25/2009
1l:55:3IAM
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
Amount Due
97.00
.4.85
11.64
$1I3.49
Amount Paid
djb
47068;
In Person
Payment Total:
$113.49
$113.49
Page I of 1
9/25/2009