HomeMy WebLinkAboutPermit Mechanical 2009-10-20
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I Permit no:??; - Is-) C. I
I Date 1/1 /J-tJ /0 7 I
Mecha'iHcal Permit Application
225 F;fth Street. Spnngfield, OR 97477 . PH(541)726.J75J . FAX(541)726.J689
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. '
l~y~~f~i~!f:~S~:~t0~G~ITr~G'9.f{~~Q'~fgQ~$TRP.9Ji.Q.N.~~;t~~f:~~F''';'~ -':~I .'!,::{:~"'~:::~'~: "'-;-~;~'lf:;"i.f"F'~E "'SCH epti LE" '..~ : c ~--'!.';~': ~-'.:'. '.' :': '.'. ':1
I D Residential I D Government I D Commercial I I~Riig(d~"hli~I;l;>;)~j!~i~t~;;;;#&i$i'~~:~liil!Qif:I~~qi!1\i}: ,);~~!al,iit-;I
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I Job site adaress: /.2 oY. #A:;/J11 t-7ZJ' /\.J IFurnace/burner including ducts and vents
I City: /S's1:Hj) I State:,,'lJt- I ZIP: '/'7'(.)1'; I Up to lOOk BTU/hr. I I
I Reference: \nO.:z. 0:1."'- 'lf2-, I Taxlot.Jm~, I lOver lOOk BTU/hr,
"I 'L.lo.J""\ V\.j.... I Heaters/stoves/vents
l'f;;5E~CRIPo,Ti.QN"()FWQRK'-:i.'::'''T,;'? ~'.F I I Unit heater
1/./C'1J C; It')' F?: i c 1\-.5 i-itv",'- I I Wood/pellet/gas stovelflue
~ '\ . . I Repair/alter/ad dt 0 heating appliance/
refrigeration unit or cooling system!
~~!~lk~?~~~~~~t;iPR~0RERTi't~0V\iN'ER~rj~~1re~!~W~:~:r~~ absorption system
t",.~~~~-"",;,;,.f.)i~t'&;>2~."j"".."", iL_.".......c.. i,~.....,,-,~._..__.!tiL_.,__,ftF!,,, __.~,.",~:t.:Cfty,
I Name: f::;/vrIVZ-cIT. 1:I:-Di2e-v <;! ,,};1'/Vc'-- I I Evaporated cooler
I Address: /..z-f "1' /7'/4"""1 t--7'ZJ,A.../ I, I Vent fan with one duct/appliance vent
-I Hood with exhaust and duct
I City: s.p Pz-- I State: 6"L I ZIP: '1 '7'-r?'! I I Floor furnace including vent
Phone:-:,"Vs" -/S-OG I Fax: I I Gas,piping
E-mail: I lOne to four outlets I I
This installation is being made on property owned by me or a I Additional outlets (each)
member of my immediate family, and is exempt from licensing I Air-handlingunits, including ducts
requirements under ORS 701.010, ' I Up to 10,000 CFM I I $11,00 I $
Signature: lOver 10,000 CFM $20,00 $
1.~~~llt~'i(~\~C0Nj;RACm0R~iNstj:l;IlIfAfj0N~~;S~~:~~"i'l I Compressor/absorption system/heat pump
I"'~:~:~:'::~~ ~=-~; "=:-;; '~~:-.;-~~;;;;;~' ';;H ~: :: ~ 5h~~~~~~:;~u I ::::~~ I ~
I Address: !.r.t;) 1I;.1-r"'1 ~i'7);"/ " I I Up to 30 hp/! ,000 BTU ' $43,00 $
I City: .:.> f' Pt.-/) I Statetj;,L. I ZIP: "77/?, I I Up to 50 hpll,750 BTU $57,00 $
,II Phone: "7'5''1'- lI? Je..-.. I Fax: 'I lOver 50 hp/I,750 BTU $95,00 $
(I E-mail:" I Ilncinerators
I' "77 ., I Domestic incinerator $20.00 I $
CCB !tcense no,: '(., ~ (
I Print name:. tt'4J<?.fi? E:'/JU db/oj I I Enter total valuation of mechanical system
1\ / / / ,j / L I and installation costs $ - .
~ignature: ! 1i7!Jt. fifiA . I Enter fee based on valuation of mechanical system, etc. I $
L U' fV''Ti't<::-'r'' ~ Ir~i~~~~~~g~~jf~~1~jiU~~~Wf~I!~!T.1'I~~1~!1'~~~~~~~~;'~
~ ' I Specially requested inspections (per hr.) $58,00 $
~ cf\. I Regulated equipment (unclassed) $13.00 $
~ ~:b\~ \~~ i~~~~~~t.~'~i
~ I (B) Investigative fee (equal to [A]) $ I
I (C) Enter 12% surcharge (.12 x [A+B]) $ 10 -~.""
I (D) Seismic fee, 1% (.01 x [A]) $ .
I (E) Technology Fee (5% of[A]) $ ~ 'j C
I TOTAL fees and surcharges (A through E): $/OO'Y-
$17,00 I $
$20,00 I $
$17,00
$38,00
$
$
$58,00
$
$13,00 $
$9,00 $
$13,00 $
$58,00 $
$7,00 I
$4,00
$ '1
$
440.2545.) (lli08/COM)
, :~
Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-01536
ISSUED: 10/20/2009
APPLIED: ]0/20/2009
EXPIRES: 04/20/20]0
VALUE:
225 Fifth Street, Springfield, OR'
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 1284 HAMILTON ST
ASSESSOR'S PARCEL NO.: 1703342200223
Springfield TYPE OF WORK: Mechanical Only
, '".TYPE OF USE: New
PROJECT DESCRIPTION: zero-clearance gas fireplace and gas line
Residential
Owner:
Address:
EMMETT ANDREW E & JANE E
1284 HAMIL TON ST A!TENTION: Oregon law requIres you to
SPRINGFIELD OR ~~+~_~~I:l!. adopte3 by the Oregon Uti/iN
," . --_.. --..."".. \IIV';'C'lu't/~i:lreSettorth
10 OAR9~2~1b1>6!Rlfi\I~ORMAJD~N I
0090,. You II-'~V1H1V' _!/!_U.r.nr.J~ u
calling the center. (Note: the tele h 1
: ContractllJinber for the .o~~9.Qn_U,ti1 'litM~lit flI@ense
AMERICAN GAeeM'~~~_~lN'~'11
I BUILDING INFORMATION I
Expiration Date
10/3112010
Phone
541-954-4686
Contractor Type
Mechanical
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
S~condary Construction Type:
# of Bedrooms:
R3
# of Stories:
Height of Structure
Type of Heat:
Water Type:
Range Type:
Energy Path:
Sprinkled Building:
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
VB
Front yard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
NOTICE:
I HI~ 'll.fflWE~~~~RMAA'~
AUTHO'lt.!.x uMJD'f Ih{b ~~"l~l/r u,".HJf
COMMENCED ,qtU~..MM'lDONED FOR
ANY 180 DAY ff~.@iree~ Rqd:
Paved Drive Rqd::, " ,
.% nfLot Coverage:'
No
REQUIRED PARKING
Total:
Handicapped:
Compact:
,'.!......
I PUBLIC IMPROVEMENTS I,
Street Improvements:
Storm Sewer Available:
Special Instruction: ,
Sidewalk Type:
DownspoutslDrains:
Notes:
I V al~ation Descriotion I
Description
Type of Construction
$ Per Sq Ft
or multiplier '
Square Footage
or Bid Amount
Value
Date Calculated
Page I 00 '
-~r~!~~~!::~.~~t.;.~:y
Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-01536
ISSUED: 10120/2009
APPLIED: ]0/20/2009
EXPIRES: 04/20/20]0
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
, ,.,
.. .
Total Value of Project
Fees PaiclJ
Fee Description
+ 12 % State Surcharge
+ 5% Technology Fee
1st Appliance
Gas Outlets 1-4
Amount Paid
Date Paid
Receipt Number
$10.32
$4.30
$79.00
$7.00
10/20/09
10/20/09
10/20/09
10/20/09
1200900000000001163
1200900000000001163
1200900000000001163
1200900000000001163
Total Amount Paid
$100.62
I Plan Reviews I
To Request an inspection call the 24 hour recording at726-3769. 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.
R.er,uired Insoections I
Rough Gas: After line is installed and required testing and capped if not attached to an appliance.
Rough Mechanical: Prior to Cover
Final Gas: When all gas work is complete.
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 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 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
'""';XtlA IN=9
Owner or Contractors Signature Date '-
Page 2 of 2
225 Fifth Street
Springfield, Oregon'97477~-~'--' m
541-726-3759 Phone
Job/Journal Number
COM2009-01536
COM2009-01536
COM2009-01536
COM2009-01536
Payments: ,
Type of Payment
Check
cReceintl
RECEIPT #:
Description .
"1st Appliance
\ Gas Outlets 1-4
:+ 5% Technology Fee
+ 12% State ,Surcharge
Paid By
AMERICAN GAS APPL SVS
~ ,:
City of Springfield Official Receipt
Development Services Department
Public Works Department
120090000000000]163
Date: ]0/20/2009
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
CJc
6375
In Person
Payment Total:
Page 1 of I
10:48:28AM
Amount Due
79,00
7,00
4,30
10.32
$100.62
Amount Paid,
$100,62
$100.62
10120/2009