HomeMy WebLinkAboutPermit Mechanical 2010-6-3
Mechanical Permit Application
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225 Fifth Street _ Springfield, OR 97477 _ PH(541)726-3753 _ FAX(541)726-3689
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Pennil no.:
Date:
3 -
This permit is issued under OAR 918-440-0050. Permits expire if work is not started within 180 days of issuance or irwork is
suspended for 180 days.
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Address:
City:
Phone,'QI-qrH{ L.f &6'&
ZIP:-
E-mail:
CCB license no.:
1
Print name:
Wo-n'"M
Signature:
~
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440.2545-) (] 1I08/COM)
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, 'FEE SCHEDULE
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9R~'iid~htia'If.1,,!ltb;;X~w!ffu'~~j>~,~,:~k:)"&;~:*" "Qty' -', f>:~_~~~t:'1>, ",~:,T~.taJ.. ,.,- J
S';-';~""1"~~"'.'''r.v'l-:". .. ~.,;!;;~~~-; ~t;:j~j~,~'j"'/1\\l1'~';';;f;.i",~,{j. .. ~;._,,)< .::_'!;:~ ea;":;it:';2'," i<f,<~i cost~:1>'
First Appliance l $79.00 $'" CI.l V
Furnace/burner including ducts and vents
7
Up to lOOk BTU/hr.
Over lOOk BTU/hr.
Heaters/stoves/vents
Unit heater
Wood/pellet/gas stovelflue
Repair/alter/add to heating appliance/
refrigeration unit or cooling systemJ
absorption system
Evaporated cooler
Vent fan with one duct/appliance vent
Hood with exhaust and duct
$
$
$17.00
$20.00
$17.00
$38.00
$
$
$58.00
$
$13.00 $
$9.00 $
$13.00 $
$58.00 $
Floor furnace including vent
Gas piping
One to four outlets
Additional outlets (each)
Air-handling units, including ducts
Up to 10,000 CFM I $11.00
Over ]0,000 CFM I $20.00
Compressor/absorption system/heat pump
Up to 3 hp/I OOk BTU $17.00
Up to ] 5 hp/500k BTU $29.00
Up to 30 hp/l,OOO BTU $43.00
Up to 50 hp/l,750 BTU $57.00
Over 50 hp/l, 750 BTU $95.00
Incinerators
Domestic incinerator
~
$7.00 $ __
$4.00 $
$
$
$
$
$
$
$
I
$
$20.00
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Enter total valuation of mechanical system
and installation costs $
Enter fee based on valuation of mechanical system. etc. $
fr''''''~'\e~:',;SI''''Y'4t'~'';';I~/~;~~~':;'''::;:'W'~\,;;''<'~N~\r,~1;:';: "~',:>Sl! llr ::Cifst....,' ;y',~ Total",
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Reinspection $58.00 $
Specially requested inspections (per hr.) $58.00 $
Regulated equipment (unclassed) $13.00 $
Each additional inspection: (1) $58.00 $
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(A) Enter subtotal of above fees (or enter set
minimum fee of $ 79.00)
(B)'Investigative fee (equal to [AD
(C) Enter 12% surcharge (.12 x [A+B])
(D) Seismic fee, 1% (.0] x [A])
(E) Technology Fe, (5% of[A])
TOTAL fees and surcharges (A Ihrough E):
nqyV
$ --
$ C\.~)I
$ -
$ "'>.~""
$ aq,.""~
Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
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CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2010-00712
ISSUED: 06/03/2010
APPLIED: 06/03/2010
EXPIRES: 12/03/2010
VALUE:
Springfield TYPE OF WORK: Single Family Residence
SITE ADDRESS: 1335 CENTENNIAL BLVD
ASSESSOR'S PARCEL NO,: 1703253310500
TYPE OF USE: Addition
PROJECT DESCRIPTION: Add gas piPi~ to appliance and cap existi'rig"gas piping,
NOTle: SMAt' OW\R51l=THEWORK
Owner: LEE DIANA K THIS PtKM11 OER THIS PERMIT IS NO I
Address: 1335 CENTENNIAL B~HOR\ZED .uONR, IS ABANDONED FOR
SPRINGFIELD OR 9';@ff.!tJlMENCED 00
DAY PERI ' " ' ,
Owner: LEE SUSAN AM ANY 180 '
Address: 1335 CENTENNIAL BLVD
SPRINGFIELD OR 97477
I CONTRACTOR INFORMA T10N .
Contractor License
AMERICAN GAS APPLIANCE SERVICE IN 77621
BUILDING INFORMATION ~
Contractor Type
Mechanical
# of Units:
Primary Occupancy Group:
Secondary Occupancy Group:
Primary Construction Type
Secondary Construction Type:
# of Bedrooms:
Frontyard Setback:
Side I Setback:
Side 2 Setback:
Rearyard Setback:
Solar Setbacks:
Street Improvements:
Storm Sewer Available:
Special Instruction:
Notes:
Residential
Expiration Date
10/31/2010
Phone
541-954-4686
.:' # of Stories:
R3 Height of Structure
Type of Heat:
Water Type:
Range Type:
Energy Path:
':'TT..ENTlO&~~i1ding: n/a
NOli ~~!W.~=I "
~ 952-DOf-oOfOthr saresetfortb
.......,. You mlli>J~!n~o~9h OAR 952-001_
calling the C1IlB1ellet(IIJ ~Ie~, therufes by
nUmber for trw.Qre9D~ ,tel~l?hone
Centes A... . ,lltlrr>... ~ NotIfIcation
10'''' ~!lr21111~).
Lot Size:
Sq Ft Ist Floor:
Sq Ft 2nd Floor:
Sq Ft Basement:
Sq Ft Garage/Carport
Sq Ft Other:
,Occupant Load:
REQUIRED PARKING
Total:
Handicapped:
Compact:
I PUBLIC IMPROVEMENTS ~
Sidewalk Type:
Downspouts/Drains:
~ " :
I ..' , " .~. ,\11>"1
,; "
Paee I 'of 2
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Status
Issued
225 Fifth Street, Springfield, OR
541-726-3753 Phone
541-726-3676 Fax
541-726-3769 Inspection Line
I V aluation Descrip~tion ~
Description
$ Per Sq Ft
or multiplier
Tvpe of Coustruction
Square Footage
or Bid Amount
Total Value of Project
Fees Paid ~
Fee Description
+ 12% State Surcharge
+ 5% Technology Fee
Gas Outlets 1-4
Minimum/Adjustment Mechanical
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Amount Paid 01,
.. :.....1:
,
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$9.48 .
$3.95 ()
$7.00'.'.
$72.00
Total Amouut Paid
$92.43
. Daie Paid
I Plan Reviews ~
6/3/10
6/3/10
6/3/10
6/3/10
CITY OF SPRINGFIELD
Building/Combination Permit
PERMIT NO: COM2010-007I2
ISSUED: 06/0312010
APPLIED: 06/03/2010
EXPIRES: 12/0312010
VALUE:
Value
Date Calculated
Receipt Number
2201000000000000619
2201000000000000619
2201000000000000619
2201000000000000619
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To Request an inspection call the 24 hour recording at. 726-3769. All inspections requested before 7:00
,." " f
a.m. will be made the same working day, inspections requested after 7:00 a.m. will be made the following
work day.
I Reauired Insnections ,
Rough Gas: After line is installed and required testing and capped if not attached to an appliance.
Final Gas: When all gas work is complete. , .I i;';. ;.;..
By signature, I state and agree, that I have carefully.examinell the completed application and do hereby certify that all
information hereon is true and correct, and I furth:e~.'certify that any and all work performed shall be done in accordance with
the Ordinances of the City of Springfield and the L;;'s 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 readahle 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.
fj\l;WA~.~ W(3jIO
Owner or Contractors Signature
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Page 2 of 2
Date
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
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City of Springfield Official Receipt
Development Services Department
Public Works Department
RECEIPT #:
2201000000000000619
Date: 06/03/2010
11 :30:50AM
Paid By
DIANA K LEE
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
Amount Due
7.00
72.00
9.48
3.95
$92.43
Job/Journal Number
COM2010-00712
COM2010-00712
COM20 1 0-00712
COM20 I 0-00712
Description
Gas Outlets 1-4
Minimum/Adjustment Mechanical
+ 12% State Surcharge
+ 5% Technology Fee
Payments:
Type of Payment
CreditCard
Amount Paid
KLK
KLK
093659 In Person
Payment Total:
$92.43
$92.43
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Page I of I
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