HomeMy WebLinkAboutPermit Mechanical 2009-12-11
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Mech~nical Permit Application
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I Pennit no d ';1- /'71.2- I
I Date: / ?-/II ju7' I
225 F;fth Street. Spr;ngfield, OR 97477 . PH(541)726.3753 . FAX(541)726-3689
This permif 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' 0 Residential I D Government I 0 Commercial ~~~!!Si~nl!!Tfjf~K~~~~;~~{;~~{~1I~191~;;I~~h~~~~~~~I~ii~~~~:~J;j
1~1~~DJ9i3~~imE,,~:iN~9R,rinA.;1'IQlII!iP;li!b]~I!!Q~~jjl~:r~Mt~'W~$i I First Appliance I j $79.00 $ 'I 7-
Job site address: '-11.0 3 5' ~(S Y . ~ I IFurnace/burner ;nclud;ng ducts and vents I,
City SP~ I StateOL I Z1P'17f 7J' I 1 Up to lOOk BTU/hr I $17,00 I $ 1
I lOver lOOk BTUlhr, '$20,00 $ I
Reference: ' Taxlot.:
I Heaters/stoves/vents
,"A bE~cRflttio~fjQj:;W.QR.K'ti.'t~::"'.;':',,\,,' I Unit heater
l.j;/vs,ftI-L- 000]) -:LAJ.sE'KI Wood/pellet/gas stovc/flue
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~~~:w;'ri~Q.d'ti-~~,,'8:.,'L.__:ili'~.__.~..'~ t!(?:L~,,~___~_n.~1V:~;t'~~~:[t?it'S3rSt~I'~!}~ absorption system
I Name:E /Y! "J)E If/-hlE~ I Evaporated cooler
I Address: L!/., 3S Drl/sy .;;;r I I Vent fan with one dact/appliance vent
I Hood with exhaust and duct
\ City: <;ppL-(> I State: [)iL ,[ ZIP'1'7'f-7% I I Floorfurnace;ncludingvcnt
I Phone5'7'/-99'? - 2')- ';1t.. I Fax: - I I Gas pipin~
I E-mail: I lOne to four outlets 1 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-handling units, inclndin~ dncts
requirements under ORS 701.010, I Up to 10,000 CFM I 1 $11,00 I $
Signature: Over 10,000 CFM $20,00 $
1~~Ljj~'j~'!;l';\!i!)C-0NtRA'e;jf0R'"li\lstAi:.'t~jAmloN~~~~;:?i~tl:;1:':~';1.~2'1 I Compressor/absorption sysfem/heat pump
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I Address: .53.)..)... /J14/1J 2j , . 1 Up to 30 hpll,QOO BTU $43,00 $
I City: :Y~rl.-J) I State:,?!L I ZIr17'1-7% I Upt050hp/I,750BTU $57,00 $
I Phone5'-11-7'IIP 6 J-~f I Fax:91( -7'+)- 'if ~ f{ I lOver 50hp/l ,750 BTU $95,00 I $
I E-maii: I I Incinerators
I ') LL- -, I I Domestic ;ncinerator
CCB license no,: 0'-& 7 7.7
I Print na~ GU.o LjI.nJ S~ J2:J..cW...~,J I
I Signatn~0 d--J;", )~ Oft I,
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440.2545.J (l1/08/COM)
$17.00
$38.00
$58,00
$13,00 $
$9,00 $
$13.00 $
$58.00 $
$7,001 $
$4,00 $
$20,00
Enter total valuation of mechanical system
and mstallatlOn costs $
Enter fee based;on valuation of mechanical system, etc. $
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.; Isee aneous~ eeSf~/itTFiB~:'ii,~}.fi~. Items ~,""~c;:e"'-'tr,~ ;r>:'{'J'",O'f:T. :.,;
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I Reinspeclion I I $58,00 I $
I Specially requested inspections (per hr.) $58,00 $
I Regulated equipment (unclassed) I I $13,00 I $
1 Each add;j;onal inspecj;on: (I) I $58,00 $
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(A) Enter subtotal of above fees (or enter set IJ 0 I
minimum fee of $ 79.00) $ I] '1
I (Bj'lnvest;gative fee (equal to [A]) $_1
\ (C) Enter 12% surcharge (.12 x [MB]) $ '1 '11-1,
I (D) Seismic fee, 1% (.0 I x [A]) $
I (E) Technology Fee (5% of[A]) $ "? ~
I TOTAL fees and snrcharges(A through E): $ '3 J- 4~_
$
$
$
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Status
Issued
CITY OF ~rKll'\GFIELD
Building/Combination Permit
PERMIT NO: COM2009-01772
ISSUED: 12/11/2009
APPLIED: 12/1112009
EXPIRES: 06/11/2010
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
54]-726-3676 Fax
541-726-3769 Inspection Line
SITE ADDRESS: 4635 DAISY ST
ASSESSOR'S PARCEL NO.: 1702324307901
Springfield TYPE OF WORK: Meclianical Only
TYPE OF USE: Alteration
Residential
PROJECT DESCRIPTION: New wood stove inserf
Owner: STRUCTURED ASSET SECUR]T1ES CORPORA
Address: 659] IRVINE CENTER DR
IRVINE CA 92618
Owner:
Address:
DEHA VEN TODD
4635 DAISY
SPRINGF]ELD OR 97478
ATTENTION: Oregon law requires you to
follow rules adopted by the Oregon Utility
Notification Center. Those rules are set forth
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'" .....-.1". .....""_ .....J. t", ~ ...... - - ~ _... - - -. - .
- roll', TR~'C, To18NF; . RM:2J1Bt;'iu1es by
~",'I\l~' -ill..; 1 J.. iliJhone
number for the Oregon Utility Notilicatign. .
Contractor Center is 1-S00-3$12~f. t;xplratlOn Date
GOOD DEAL METAL PRODUCTS ]NC 26743 08/26/2010
Phone
541-736-9876
Contractor Type
Mechanical
I~~ILO~NG INF~RMATlO~,.1
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
R-3
# of Stories:
Height 01' Structure
Type of Heat:
Water Type:
NOTIG~ange Type: .
Energy Path:
THIS PErspJ\hhRWl\B~irui~nd:qE IF THFni~fOR}(
^IITUnn17!":'".r\ r Illlnr:D '"UIC nCDl\l11T Ie:. t\HiT
Lot Size:
Sq Ft ] sf Floor:
Sq Ft 2nd Floor:
Sit Ft Basement:
Sq Ft Garage/Carporf
Sq Ft Other:
Occup~nt Load:
Front yard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
WI} E~EllQP,.IVIE NT~I NFO RM\\TI 0 N': I r\
ANY 1 ao DAY p;:R\n- .
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
0/0 of Lot Coverage:
REQUIRED PARKING
Total:
Handicapped:
Compact:
I PU~L1C IMPROVEMENTS I
Street ImprovemeJ1t~:
Storm Sewer Available:
Special I nstruction:
Sidewalk Type:
Downspouts/Drains:
Notes: '
, Pa2e 1 01'2
Status
Issued
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-01772
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
I Valuation Descriotion I
Description
Type of Construction
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Value
Date Calculated
Total Valne of Project
Fees P,~id I
Fcc Description
+ 12% State Surcharge
+ 5'Y. Technology Fee
1st Appliance
Amount Paid
Date Paid
Receipt Number
$9.48
$3.95
$79.00
12111/09
12/1]/09
12111109
220090000000000]377
2200900000000001377
2200900000000001377
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~ouir~rllnsne,dions I
Preliminary Inspection: ,Prior to the installation of solid fuel appliance which will be vented through an existing
chimney.
Wood Burning Insert: After installation.
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 fui-thcr 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 structnre withont permission of the Community Services Division, Building Safety.
I further certify that only contractors and employees who arc in compliance with ORS 701.005 will be used on this project.
I further agree to ensnre 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
:7 "ring construction. '(J )
'- - 0 1A -I, cz{Jp~~_ / d-/;{ /07
'ner or co'(flactors Sign.:r~re {} Date I
Paee 2 of 2
225 Fifth Street
Springfie!4, Oregon 97477
541-726-3759 Phone
Job/Journal Number
, COM2009-0 1772
COM2009-0 1772
COM2009-0 1772
Payments:
Type of Payment
CreditCard
cRcceintl
RECEIPT #:
Description
I st Appliance
+ 5% Technology Fee
+ 12% State Surcharge
Paid By
GOOD DEAL METAL
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:~ ' "
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.~....-
City of Springfield Official Receipt
Development Services Department
Public Works Department
2200900000000001377
Date: 12/11/2009
Item Total:
Check Number Authorization
Rccei\'ed By Batch Number Number How Received
cjc 028186 In Person
Payment Total:
Page 1 of I
2:33:28PM
Amount Due
79,00
3,95
9.48
$92.43
Amount Paid
$92.43
$92.43
1211 1/2009