HomeMy WebLinkAboutPermit Mechanical 2009-12-11
Me~hanical Permit Application
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I Permit no, {! <j-I 'I '/ ! I
I Date: I ~ / / I / 0 '7 I
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,This permit is issued under OAR 918-440-0050. Permifs expire if work is not sfa'rfed within ]80 days of issuance or if work is
suspended for 180 days.
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I 0 Residential j 0 Government ,I 0 Commercial _
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Job site address: Lfd-./' (1/, lfO't1"\.. I
I City -.SfJ/:::LiJ I State: Dil-l ZIP:q?'f-1f'1
I Reference: ' I Taxlot.: I
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I ~7f}LL WOO]) .:r::tV5EfLl I
I":'\'<;!<;'I~')'<:-;:" FEE"SCHEDULE," ", ; ;'':'\\': "";',"
IK'Rli'~id~~ti~I~~Yi.@l~~~)!~;d;lt;l,\&~~tilhtYil!l;~S,g~~\)i~lk::i;!'~tal.;:,,:
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\Furnace/burner including ducts and vents
1 Up to lOOk BTU/hr. '. I I
lOver lOOk BTUIhr.
I Heaters/sfoves/vents
I Unit heater
I Wood/pelleVgas stovelflae
jRepair/alter/add to heating-appliance!
refrigeration unit or cooling system!
li!;1il_"t4f~1~~R[q~~J:{rr:'6r~'QW.~~R.!l'i:4~~~J\i~{t!,I~~ absorption system
I Name: / I Evaporated cooler
I / I ~/ A / / 10 1 Y\ .1 Vent fan with one ducVappliance vent'
Address: -r ~ IV, I
' I Hood with exhaust and duct
City: </rt--D I State:OL I zIP:9'7'f-7J" I Floor furnace including vent
Phone: 9!f 7.J-& % 7~ Fax: I I Gas piping
I E-mail: lane to four outlets I I
This installation is being made on property owned by me or a I Additional oatlets (each)
member of my immediate family, and is exempt from licensing I Air-bandling units, including ducts
require[Ilents under ORS 701.010, 1 Up to 10,000 CFM I I $11,00 I $
Signature: laver 10,000 CFM $20,00 $
~i~"?$~t'l!ilt'bNj;RAC1fOR~INsmAtfIiAflbN,W#}~\\~\1j~~~~t;lj I Compressor/absorption system/heat pump
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I Address: -\=?:J. ~ fl/l1'1, tV Sf I I Up to 30 hpll,OOO BTU $43.00 ,$
I City: SfJrLD ' I State:O/Z.. I zIP:51?f-7J7 I Upt050hp/I.750BTU $57.00 $
I Phone: tif/- ?<fl.a -i. d..>-! I Fax5':1/-1<Jf '-f! ~7', i Over 50 hpll,750 BTU $95,00 $
I E-mail: I Incinerators
I 11_:> I Domestic incinerator
CCB license no.: -2h 7'-J
I Print n~' :J'i-:.v2../LDL~/rU ..5d6 Mo~) ,
I Signature' '.iDr:h~\~ YL-R"
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225 Fifth Street. Springfield. OR 97477 . PH(541)726,3753 . FAX(541)726-36S9
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440-2545.) (II/OS/COM)
$17,00 I $
$20.00 $
$17.00
$38,00
$
$
$58,00
$
$13.00 $
$9,00 $
$13,00 $
$58.00 $
$7,00 I $
$4.00 $
$
I Ente,r total v~luation of mechanical sys.tem
and installatIOn costs $ _ c
I. Enter fee based on valuation of mechanical system, etc. $ [J/q- ...--
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I Reinspection - $58.00 $
I Specially requested inspections (per hr.) $58.00 $
I Regulated equipment (unclassed) $13,00 $ 1
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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]) $ 1
I (C)Enter 12% surcharge (.12 x [A+B]) $ 0 ':0-1
(D) Seismic fee, 1% (.01 x [A]) $ [,
I (E) Technology Fee (5% of [A]) $ ,<1 '> 1
I TOTAL fees, and surcharges (A through E): $ '1k j.lj-
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Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-01771
ISSUED: 12/11/2009
APPLIED: 12/11/2009
EXPIRES: 06/11/2010
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 42] 40TH ST
ASSESSOR'S PARCEL NO.: 17023] 1404007
Springfield TYPE OF WORK: Mechanical Only
O,vner:
Address:
TYPE OF USE: Alteration
PROJECT DESCR]PTlON: Wood stove insert ATTENTION: Oregon law requires you to
follow rules adopted by the Ore~on Utility
IWlU'''ctllUII ",mler. I nose rUles are set torth
WEST MICHAEL K & DONNA S in OAR 952-001-0010 through OAR 952-001-
421 N 40TH ST , 0090. You may obtain copies of the rules by
SPRINGFIELD OR 97478 calling the center. (Note: the telephone
UWII'IJCiI_IVI 1I1tl'_ VI t=YUI I UUlUY .."ouncauon
I CONTRAe~o~p~p~M~'.
Residential
Contractor Type
Mechanical
Contractor
GOOD DEAL METAL PRODUCTS INC.
License
2674~
Expiration Date
08/26/20] 0
Phone
54]-736-9876
I BUILD]NG INFORMATION I
# of Units: '
Primary Occupancy Group:
Secoudary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
# of Stories: Lot Size:
R-3 r~OTl(fL,,!ght of Strncture Sq Ft ]st Floor:
THIS prm~l~f fNl~lL EXPIRE IF THE WOR~q Ft 2nd Floor:
\ UT Watet:.1,'Yl1e: . q Ft Basement:
, HOR~;;~~ITy~~lER THIS PERMIT IS NO Sq Ft Garage/Carport
'OMME~~i~9 i!lUl.\S ABANDONED FOR Sq Ft Other:
"jV If:''''''' "-""il- ' .
, , Spdnl{led:nui ding: n/a: Occupant Load:
I DEVE~OPMENTINFORMATION I
REQU]RED PARKING
Front yard Setback:
Side] Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
Total:
Handicapped:
Compact:
I PUBLIC IMPROVEMENTS I
Street Improvements:
Storm Se\\'cr Available:
Special Instruction:
Sidewalk Type:
Downspouts/Drains:
Notes:
I Valuati~n Descrintion I
Description
TYlle of Construction
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calcnlated
."--.
Pa2e I 01'2
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Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-01771
ISSUED: 12/11/2009
APPLIED: 12/11/2009
EXPIRES: 06/11/2010
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
54]-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
12111109
12111109
12111109
2200900000000001378
2200900000000001378
2200900000000001378
Total Amount Paid
$92.43
I 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 R.e/luired Insnections I
Preliminary]nspection: Prior to the installation of solid fuel appliance which will be vented through an existing
(,'himney.
Wood Burning Insert: After installation.
By signatlll'e, I state and agree, that I have carefully examined the completed application and do hereby certify thaI all
informution hereon is true and correct, and I further certify that any and all work performed shall be done in accordance with
the Ordinances orthe City of Springfield and the Lan's urthe 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
tim uring construction.
A 0
er or Con~ctors Signatu:e
.-/
/1/ !o 9
Date
I
Paee 2 01'2
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2009-0 1771
COM2009-0 1771
COM2009-0 1771
Payments:
Type of Payment
CreditCard
cRcceil111
RECEIPT #:
Description
I st Appliance
+ 5% Technology Fee
+ 12% State Surcharge
Paid By
GOOD DEAL METAL
T1:Q"';4fij;
1I\i:"..'
,City of Springfield Official Receipt
Development Services Dcpartment
Public Works Dcpartmcnt
2200900000000001378
Date: 12/11/2009
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
cjc 078611 In Person
Payment Total:
Page I of I
2:39:24PM
Amount Due
79.00
3,95
9.48
$92.43
Amount Pllid
$92.43
$92.43
12/1112009