HomeMy WebLinkAboutPermit Mechanical 2009-12-11
Mechanical Permit Application
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225 Fifth Street. Springfield, OR 97477 + PH (54 1)726-3753 . FAX(541)726-3689
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I Permit no,: (!/l ~ (")/7hd
I Date: / d --II'" Oi I
This permit is issned 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. '
1 ~Residential I 0 Government I,D Commercial
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Job site address:~ 0 5 l LJ R R. 0 f\ V E .
I City: 5PR.IN~ "I ~LO ,I State: OR.. I ZIP: C(1l.f71
I Subdivision: Lot no.;
INSTAL..."''\IQrv O~ l,<,nM) ",TmH AMlO
Cl...{\-SS Pi CI-\IMNE'1
I Name: 'JAMiS WALK E\IZ
I Address: -:, 0' 51LJ^ II.. () AVl ,
I City: ;SE>RINb fltLt) I State: O/Q.
I Phone: 5'+ 1- I U. -'-/2' 0 I Fax:
I E~mail: 'B/b_JIM _WAL.I\:~~ ~ A1T" /11fT
This installation is being made on property owned by me or a
member of my immediate family, and is exempt from licensing
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I Business name: I
I MOress~ I
I City: ~~............... I State: ,~ I
I Phone: ________ I Fax; /'........ - I
I E-mail: ><-- I
I CCB license no,: ~ I
I Print narpe:-/" '" I
I Sig~~;ure: I
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I ZIP: 0(7477 I
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440-2545-J (I tl08/COM)
I First Aopliance I
/Furnace/burner including ducts and vents
I Up to lOOk BTU/hr. I $17,00 I $
lOver lOOk BTU/hr, I $20.00 I $
I Heaters/stoves/vents
I Unit heater I I $17,00 I $
Wood/pellet/gas stovclflue $38,00 I $
Repair/alter/add to heating appliance/ $58,00 I
refrigeration unit or cooling system! $
absorption system
I Evaporated cooler $13,00 $
I Vent fan with one ductJappliancc vent $9.00 $
I Hood with exhaust and duct $13,00 $
I Floor fuma_ce including vent $58,00 I $
I Gas pipirig
I One to four outlets I $7.00 I $
I Additional outlets (each) I $4.00 $
I Air-handling units, including ducts
I Up to 10,000 CFM I I $11.00 I $ I
lOver t 0,000 CFM $20.00 $ I
I Compressor/absorption svstem/heat pump I
I Up 10 3 hp/100k BTU $17,00 $ I
I Up to 15 hp/500k BTU $29,00 $ I
Up to 30 hp/I,OOO BTU $43,00 $ I
I Up to 50 hp/I ,750 BTU $57.00 $ , I
lOver 50 hp/l,750 BTU $95,00 I $
I Incinerators
I Domestic incinerator $20.00 $
I Enter total valuation of mechanical system
and installation costs $ _
I Enter fee based on valuation of mechanical ,system, etc,
I $ I
sfii"Total~~1
~3cost~j
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I Each additional inspection: (I) I I $58.00 I $ ..I'
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I (A) Enter subtotal of above fees (orentcr set ~
minimnm fee of $ 79,001 $ I f'
I (B) Investigative fee (equal to [A]) $ '3 _ q)5
I (C) Enter 12% surcharge (.12 x [A+B]) $ Of'~
I (D) Seismicfee, 1% (.01 x [A]) $ 1
I (E) Technology Fee (5% of[ A]) . $ I
I TOTAL fees and surcharges (A throngh E): $ 9). , ~
I Reinspection
I Specially requested inspections (per hr.)
I Regulated equipment (nnelassed) I
$58,00 $
$58,00 I $
$13,00 I $
Status
Issued
CITY OF SPRINGFIELD'
Building/Combination Permit
PERMIT NO: COM2009-01766
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
TYPE OF USE: New
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SITE ADDRESS: 30 SEWARD AVE
ASSESSOR'S PARCEL NO,: 1703224400200
Springfield TYPE OF WORK: Wood Stove.
PROJECT DESCRIPTION: Freestanding Woodstove
Owner: WALKER JAMES M & MARLA M
Address: 30 SEWARD AVE
SPRINGFIELD OR 97477
I CONTRACTOR INFO~ATWN .
Contractor Type
Mechanical
Contractor
OWNER
License
Expiration Date Phone
~U1LDING INFORMA",:~ON I
# of Units:
Primar)' Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
# of Stories:
Height of Structure
Type of Heat:
Water Type:
Range-Type:
Energy Path:
Sprinkled Building:
Lot Size:
Sq Ft I st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
Occupant Load:
u/a'
'1 DEVELOPMENT INFORMATION I
REQUIRED PARKING
Front yard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rlld:
0/0 of Lot Coverage:
Total:
Handicapped:
Compact:
I PUBLIC IMPROVEMENTS I
ATTENTION' Ore ,
follow rul.... ~..^^.~~nc a~ requIres you to
lVot/tication Center ih;~ l"~,...".gon utility
In OAR 952-001-0010 thro~g~ OAare setforth
~ali'oll:maYobla' . R952-o01.
callin th In copies of the rules by
~'m'~nm~. (Note: the telephone
<;e~tereiso:~O~~~~~lificatjon
~ ~
Street Improvements:
Storm Sewer Available:
Special Instruction:
Notes: NOTICE:
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AUTHORIZED UNDER THIS PERMP~aJl~Wion Descriotion ,
~OMMENCED OR IS ABANDONEe r!: .
, ":V i RO nl'tV P~PIOD, $ Per Sq Ft
DeSCriptIOn Type of Construction I ' I'
or mu tIp IeI'
Square Footage
or Bid Amount
Value
Date Calculated
Page 1 of 2
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
. 541-726-3676 Fax
541-726-3769 Inspection Line
Fee Description
+ 12% State Snrcharge
+ 50/0 Technology Fee
I sf Appliance
Total Amonnt Paid
Amount Paid
$9.48
$3.95
$79,00
$92.43
Total Value of Project
!'ees Paid'
I Plan Reviews ,
Date Paid
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-01766
ISSUED: 12/11/2009
APPLIED: 12/1I/2009
EXPIRES: 06/11/2010
VALUE:
12/11/09
12/11/09
12/11/09
Receipt Number
2200900000000001371
2200900000000001371
2200900000000001371
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.
Wood Stove: After lilStallation,
Refjlliredlns.Ilections I
By signature, I state and agree, that I have cai'efully examined the completed application and do hereby certify that all
information hereon is true and correct, and I further certify that any and all wor~ performed shall be done in ac.cordance 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 ,,\,ho 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
times during construction,
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Owner or J~ractors, Signature
Paee 2 of 2
12(1([ '2.00 0,
Date
225 Fifth Street '
Springfi~ld, Oregon 97477
541-726-3759 Phone
Job/Journal Number
COM2009-0 1766
COM2009-0 1766
COM2009-0 1766
Payments:
Type of Payment
Check
cRcccintl
RECEIPT #:
Description
I st Appliance
+ 5% Technology Fee
+ 12% State Surcharge
Paid By
JAMES W. WALKER
City of Springfield Official Receipt
Development Services Department
Public Works Department
2200900000000001371
Date: 12/11/2009
IO:47:50AM
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
Amount Due
79.00
3,95
9.48
$92.43
Amount Pelid
njm
1891
$92.43
$92.43
In Person
Payment Total:
Page I of I
12/1 1/2009