HomeMy WebLinkAboutPermit Mechanical 2009-12-16
Mechanical Permit Application
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I Pe~itno; r19-/'79L/ ,I
I Date; 12}lh/D71
This permit is issued under OAR 918-440-00S0.,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 'g) Residential I D Government ,I D Commercial I
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/ Job site address; {pt::>/, s.".,.# 3STH ofT ,
\ I City; :S'P~l:> 1 State; .:>2. I ZIP: 97~7e 1
\( Reference: . l Taxlot.;
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, I City; S7.LZl 1 State:.e>;C I ZIP' "17~7e 1
\1 Phone~i'/-1ZIS -6P77o 1 Fax; 1
~ E-mail: 1
This installation is being made on property owned by me or a
member of my immediate family, and is exempt from licensing
requirements under ORS 701.010,
225 Fifth Street. Sp,ingfield, OR 97477 . PH(541)726-3753 . FAX(541)726-3689
Signature:
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1 Busin~ss ~a~;-f...c:lUl.l... 7>o~ J ?HT~D ' I
\ I Address; . I
\1 City; f ~ (; e,..e, 1 State: ~ IZ. I ZIP: 1
, Phone;"'i'/-~ ~1!P"'b ' 1 Fax; I
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, E-mail:
'I CCB license no,:
II Z '1~
Print name:
Signature;
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440-2545-) (11/D8/COM)
";:.,"'''j;:~';:~i: ;:J:'r:o'FEE "SCHEDULE '
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IFurnace/burner including ducts and vents
1 Up to lOOk BTU/hr, I I
lOver lOOk BTU/hr,
I Heaters/stoves/vents
I Unit heater
I Wood/pellet/gas stove/flue
I Repair/alter/add to heating appliance/-
refrigeration unicor cooling system! <
absorption system
I Evaporated cooler
I Vent fan with one duct/appliance vent
I Hood with exhaust and duct
I Floor furnace including vent
I Gas piping
lane to four outlets I I
I Additional outlets (each)
I Air.handling units, including ducts
I Up to 10.000 CFM II $11,00 I $ I
laver 10,000 CFM , $20,00 $
I Compressor/absorption system/heat pump. I
Up to 3 hpflOOk BTU $17,00 $
1 Up to IS hp/500k BTU $29,00 $ I
'I Up to 30 hpfl,OOO BTU $43,00 $ I
1 Up to 50 hp/I,750 BTU $57.00 $ I
laver 50 hpfl,750 BTU $95,00 1 $
I Incinerators I
I Domestic incinerator . l $20.00 J $ I
IJC'ornm'~Yci.~J~$:~~;~;}'~0;i~r;~~;~rftt!i?#~~!1,\~f"~5;ft~~mf~f,~~~1Y~1::;~~~1
I Fnte,r total v~luation of mechanical sY,~tem
and mstallatlOn costs $ _ .
I Enter feebased.on valuation of mechanical system, etc. $
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I :,t~;::;,:;~:;~r~";''''''''''~:'T';''''-1'fP~Yi'1~~;ti!:''~'il'tt.'i', (t";::~.,,,,; ,ol5:;J$e:~~~~;'" )~~,cost".'1J_"~1
I Specially requested inspections (per hr.) $58,00 $ 1
\ Regulated equipment (unclassed) $13,00 $ I
1 Each additional inspedion: (I) $58,00 $ 1
1~~~!il~ii!i'\'E;i~j{(][CAJ\iT~~USE~"\!~~.ill'fi~
I (A) Enter subtotal of above fees (or enter set OJ
minimum fee of $ 79,00) $ '7 I
I (B) Investigative fee (equal to [A]) '$
I (C) Enter 12% surcharge (,12 x [A+B]) $ 01./ l
1(0) Seismicfee, 1%(,01 x [A]) $
I (E) Technology Fee (5% o[[A]) , $ ;3 '" \;
I TOTAL fees and surcharges (A through E): $ q b ~
$17,00 1 $
$20.00 I $
$17,00
$38,00
$
$
$58,00
$
$13,00 $
$9,00 $
$13,00 $
$58,00 ,$
$7,00 I $
$4,00 $
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-01794
ISSUED: 12/16/2009
APPLIED: 12/16/2009
EXPIRES: 06/16/2010
VALUE: .
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541_726-3'769 Inspection Line
--............
':'1. '"" "UN; uregon raw fllQ,'IImlI- fA. ' .
SITE ADD~ESS: 601 S ~5THJI!tJ;y ~Ies adopted by thetlrego~r PE OF WORK: Mechamcal Only
ASSESSOR S PARCEL NO" Ndll~C~~ter. Thosetulesar88etf~ '
In OAR 952-001;-0010 through OAR 952.(1()1: E OF USE: New Residential
PROJECT DESCRIPTION: 19aeor~lfl~'tJI!II&ln copies of the rules by
calling the center. JNotlli JtlA,. teJ..l'b"....
Owner: CORNUTT RODN~~'b"~~~egon Utility Notlficallon
Address: 601 S 35TH PLACE -800-332-2344),
SPRINGFIELD OR 97477
...... "--
1.,~.ONTRACTOR-JNFOR~.A TlO~ ,
Contractor License
EMER.;\.kQ 1>~IMMING POOLS OF ORE IN 11294
f'liVI.",';
THIS . 1-. n,~ILDINGINFORMATlON I
PERMIT v'l,r,l...l... L.1\1 IIIL.. If Ilia: ~~vn(\
# of Units: AUTHORIZED UND6Pof~&irefRMIT IS NOT
Primary Occupancy Group: COMMENCED OR 1~1i.~\lj!j(;lf1!I!Utji@R
Secoudary Occupancy Group:ANY 180 DAY PERI~pe of Heat:
Primary Construction Type Water Type:
Secondary Construction Type: Range Type:
# of Bedrooms: Energy Path:
Sprinkled Building,
Contractor Type
Mechanical
I DEVELOPMENT INFORMATION ~
Front yard Setback:
Side 1 Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Overlay Dist:
# Street Trees Rqd:
Paved Drive Rqd:
% of Lot Coverage:
I PUBLIC IMPROVEMENTS I
Street Improvements:
Storm Sewer Available:
Special Instruction:
Notes:
I Valuation DescriDtion I
Description
Type of Construction
$ Per Sq Ft
or multiplier
Square Footage
or Bid Amount
Page 1 01'2
'Expiration Date
10/23/2011
Phone
, 541-688-1090
n/a
Lot Size:
Sq Ft 1st Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq FtGarage/Carport
Sq Ft Other:
Occupant Load:
REQUIRED PARKING
Total:
, Handicapped:
Compact:
Sidewalk Type:
Downspouts/Drains:
Value
Date Calculated
Status
Issued
Lll Y OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2009-01794
ISSUED: 12/16/2009
APPLIED: 12/16/2009
EXPIRES: 06/1612010
VALUE:
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
Total Value of Project
Fees Paid I
$9.48
$3,95
$79,00
12/16/09
12/16/09
, 12/16/09
Receipt Number
2200900000000001393
2200900000000001393
2200900000000001393
Fee Description
+ 12% State Surcharge
+ 5% Technology Fee
1st Appliance
Amount Paid
Date Paid
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 ~,~(l\li"'ed lnsnections,'
Preliminary Inspection: Prior to the installati~~, of solii! 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 further certify that any and all work performed shalLhe 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 strncture 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
time~r2#
/7-/6 -c7j
Owner or Cont"tors Signature
Date
\
Paee 2 of 2
225 Fifth Street
Springfield, Oregon 97477
541-'n6c3759 Phone
Job/Journal Number.
COM2009-0 1794
COM2009-0 1794
COM2009-0 1794
Payments:
Type of Payment
Check
cReccintl
RECEIPT #:
Description
15t Appliance
+ 5% Technology Fee
+ 12% State Surcharge
Paid By
RODNEY CORNUTT
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City of Springfield Official Receipt
Developme~t Services Department
Public Works Department
2200900000000001393
Date: 12/16/2009
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
cjc
660
In Person
Payment Total:
Page I of I
9:45:42AM
Amol;lnt Due
79,00
3,95
9.48
$92.43
Amount Paid
$92.43
$92,43
12/16/2009