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HomeMy WebLinkAboutPermit Mechanical 2011-2-10 01/28/11 FRI 16:19 FAX 5417263689 Mechanical Permit Application :'!'. ',t"., " ,.- '_ '-.' ; ~ ',...,... ,~. ,'.. -. . .' . ,I ,.'~;. I i--{J~!t~ qf,~SP:R_!NGf.J;Jn~:D>~,9R.EWlN;,: I 225 Fillh S= . SprinzjieJd, 01< l726-3689 CITY OF SPRINGFIELD 14J002 - .......~........ '. ~ ~, - ~- ~.--. .,',' ',:,",<;, _"'r.. .-._-;......~.;;.-_..: . "'''~, '.'- =...>o-:\\o.:...~:.. '::,,:!~m:I>AR1ivIE!(f-USE ONlY."'\;,~. ~.:...' .- ..'t' . l .' ".'."- .,' ,.".... :.,.:". . "; ;'.' . ..~.....: Penn it DO.: 5n L - L-6.3 Date: 2--- J61' 1.1 expire if work is not started within 180 days ofissuante or if work ii This permit is issued und suspended for 180 days. ):r~.i!:;~':?~.::~1~~Jt1!..'.::.;;", ::.v-;-..:'...:.....:.:. o Residential 0 Oovenuneut 0 Comml!rcial .~~1\::'J..~Q)3$i1fi;7ijlfj:'Qf{~,-~,1igl'l!\i-l;;i\1iit;:liW~I~>:~f-:(;!;." "1~ Taxlot: 'I :DE!\C~lItrJPN {)j: .WQRIC:-:-" u;::.' -. ~~4.t~~~~;{~ff~!~i~.t~fJi~~~~~+.ft\~~y~~~~1:~?:~J;;;~ Name: Address: City: ?. Pbone;21 - /!) E-rnail: .;....u. _ beu.'" e.. 5 w.t... <'0 W1 This installation is being made on p~erty owned by me or a member of my immediate family, and IS exempt from lle.ensing n:quifemcnts under ORS 701.010. Signature: .,~\\,;i;,:.ii'i;-;t~-"'.O-"""'~';-""'';;'. .,..~;jN..;;1i.j:,.''''-'''"Q......".:;~'''':,;:.:.'ij.'h:,.-,..'~.., .<.~";_-.:u ,;(J,"'~.I!.;lI~y;I., ~"~-~~~.,II "~~~,':'. ....... ~-...':. ".' Business name: ~"" ~~ If' Address: I.' / City: Phone; E-mail: CCB lieense no.: Print name: ~ Signarurc: 44O--2$45-J (1l108ICOM) .~. .. , ~.. "w., ,.\ :: ' " 1"8: . $~ijEDULE .. ~!~~~MJ~~i~!~~~.f.;~~~~{~{~i~l~ ~~ :f~~{~ {.~;~1~~ First Aeoli",ee $79.00 $ Furnatt'lburne:r ine:luding dUcUand venti . Upm 1000BTUIbr. .,..-- .. 0...- lOOk BTUIhr. Heaters/stoves/vents Unit helllei' Wucdlpellc:t/gas stevtl:flue Repllidalterladd to beating appliancd rofrigOl1ltion ucit or <ooling systeml absorprlen system Evaporated cooler V""I fan with one duct/appliance vent JIood wim exhaust and duct P1oorfumoee lnoludiug villi! Gas piping One to four oullets -Addilional ourletS (each) Ai....ha"dling o"its, inclodinl! ducts Upte IO,OOOCFM ,T $11.00 I $ Over 10.000 CFM I I $20.00 I $ ComDressor/absorotioo svstemlbeat riumu Up 10 3 hpll OOk BID Si7.00 $ Upm IShp/500kBTU $29.00 $ Up Ie 30 bpll,OOO BID S43.00 $ UpmSOhp/l,7S0BTU 557.00 $ Over SO hpll.7S0 BTV $95.00 $ Incinerators ' , Domestie ineineralcr I I 520.00 I $ $17.110 S $20.00 $ 517.00 $ $38.00 $ :158.00 S $1~.00 S $0.00 $ $1~.OO $ SSB.OO $ , I I $1.00 $ 54.00 I $ :?ComT*eMi~~;~~~f~:;.'j.q-~'r,t~~1~~{~;~j~~~~";(;:,~~~~~;~~.?::::.=:-~? Enter total valUlllion of mechenical systllm and instaIlaIien costs S M.Cx::13 ,Z.tJ Bnta'ti:e based en va1uation nfmcehaoicaJ >iYstcm, eIe, S ;;',,~~:'~1~eo~""~.e~~)i' ,'~~:"'!::n~:}.;~ ;'te~1:.'>.;:Gbit.:.;~ "'.~Total\'" ~:~~~!J1.!~:..r.",~.~~~~~,:::::~,r'h;:~r,;;,~;:' ~~,.u~~:.: :.:::!ei..~.~t.'" ;. iort;;- ;. Reiespection : - $58.00 $ Specially requested inspectious (per hr.l: $58.00 S Reg\Jlared equipment (uncJassed) $13.00 $ Each additioonl in'l*Ilo", (1) $58.00 S ,-~"""'"=,-,-",,,,<-- "'~"ii'!iI" .-.........-.se" ...".....,.. .-.=."",,-.~ ;~"<.;;~~~,;;\';'~.r_"'';-r~~r. lk'io : ~'~~I~; '::-()=,,,,,,':i~~~'r';I!'t~:~,,,,~...;,~~ ...:.:;~:.._...~:<.,~...:;.~:;~\~-. .r~~.._._~JJ!I':"',.;~ ", _;.~.."r.:~'.i..~~:-..':;::'--:~,..-:~:.},'.:11:-' (A) Enter subtotal ef above fees (er outer sei minimum fee of $ 79.001 ! (B) In...ligoljvc ree (oqu.lto [All i (C) Emc::r 12"4 surcharge (. 12x [MBll i (D) Seismic r.... 1%(.01 x [AD i (~) Tecbnolegy Fee (5% ef [A]) I TOTAL "'es and aurchorges (A througj. E): $ $ S S $ $ Feb 031109:598 Rogue Valley Plumbing LLC 02-03-11 :09:36AM: 01/28/11 FaI 18:19 FAl 5417283889 5419555117 Rogue Valley Plumb;5Ja-oHH-llUo crTY OF SPRINGFIELD p.2 If 1.1 I. lii001 Plumbing Permit Application ~~ .";~"mAATMENtjjsE'aN"V,ti~; . ~. .... . " . . ~ , . . ~.i1:". PcnnilllO': sLl-- .li;3 Dob:: 2- -{" ~/.. CITY OF SrRIN(i;FIELD, ORF.(;ON 22S ftnll ~". Sp~nlll'l<I, QR n4n . PH\!l41)7.1W751 . fAXII4I)726.JU' Thill permit is issued und.. OAR 1118-7BO.oOfiO. Pennl16 ....asued ollly 10 tho JlCI'Sou orconll1lolor doin& Ill. work. Permits ei<piru i1'work it nollb.thd witbitl18D dar" or j......... or nwork is s~speudeG for 180 duys. . G~--::~""or,',;::'~~"~1fE~J.~~~~:~~r ~J,:,..~,~t.4P.;l}.:.'f.~l!Ii$}lEUIl!lEl'ii..';:1:i..'If.rIi-,:_~"I;~.I~~ " . .... 'r\ . ,.. . .~. ... .... ....... .,-, ~. , Zoning approVBI vCrlfied' DYe. DNa ~'...' ....."......,"c. ,"'. \>...,~.:-~j~.ccSt:1ri?'ili>'P ~:o.'qi;lJl,I~\iJ~~/":.,;/ti'''''''''''~ tr...... .c;.., Jl : , SaIIitaliDII appro~l wriflCCl? DY~ DNo p~I.~t,;o: ~'." \ ~!t~~.. t~:;,.fC~~/;;;'. '. ~. "''''':~l.ii ~~O~\:'. 'New residential : , CATE~ORY.eF COl!lSTRUCT~. ",. V 1 bolllrooll'JI kboh.. (11It:I.." fi'" , ! ~ ~~.':'~. ..1 CJOO"l>rllIll~~ . _ I J!ti'C01lll'Ilerclol .00/." ojWl1IrrI:m<" 1-. MI, . S23UD S IIlhl, '~e PU1'W. IlMfrJlGf1r'low.-rrdnl ';.",.:'i{~' ..' :e'1lNEOR:l\fA1'les~;Mt . . .- "~,~:~.~. drain> tJnIl ",lJz.bolnllO,!tDgot Sob site addrcos: ""71:1:.. u., ,",oj. l ba1llroomsfl kltoh", snUD $ Cit)I~ I .fl...1 lstol>:: ,",po I ZIP: - -<or"" J b~n>D1Il5II );itehm $439.00 S I!adl addIrloaol badlroom (0VCl')) $SUO S Kefar<<lCa: - 11'aXl0l.: - .-...J, .ddiliOJl1ll kilobco (0'''' I) i S95.DD S .~~~~r;' .~;#~\',;DEscml''tI~~;O,",~WO~.;(j,*",,",;:"~_\",;_;2i!-.i R!riunlial fin SllriDkI", iio.rudu.;",. m:- DlC2.DOO_r... S5ll.DD S 2,001 '0 3.'OD SlID"" I'm S11UO S ."-, . ."_'.. _p.;RO'.P.Eamt:.'OW;,reEt.t:.':.f~fl~:o;.~7~~-'iir~~: 3,601..7.'W0_JCCl I $IT4.DD S .. ",'.l' , NIIAU:I: .L . .t.' /-"'1-1-1....._... 1:~OI llCl.....r...U1dSJllIllllt ; $23%.00 S ",;'" .... ..' . 1-a.,J.,J MI.""'ctured dMllioo or-...flb/,ir,le~..l Addc...: COlI.~.::l~ to bu~di'a_1lld I! I _00 $ Cit)l:..... ~~- I Sm..! ~ I ZIP:..", '1" , wata'su CO....~;t..,.....,..w. And d...lIillllourr IUd -- or l'l>ou", "-';:.." I Fax: - - two-famt E""ail: '//on"~- ...~.....,I ~@ s..~...."...\... .CC- MiDimulII rcc I i I m.DD I s Thi$ insIallaliOll is b.lng m1ld<l on residenlinl or I'anu propedy Eocb 1lxIu.. 1";1 I S1MD I S?-;::; : P' owned ~ "I. or a mi:mb<r of my i:lllliodllll!: ~. ond ;$ MisceU.nC:OUll reel I c:J<CIllpl DRIll_sing requlromen1S under OAR. 9 S..wl.o020. 100' slarm, _. _lIno b..k. $75.00 s 7?<; Signzluro; S..h r.,.......ll>I>u........... and pipi~ ! SU.01l S CONTRAC"F.C'l1.l .1NS'f",'U.A".1lJJN ..~" ." .:!. "" ,,;.- S\Dfm 'Yfal.'CfteW'luoDfdd.mtion t'u:Uity , SU.DO S . BW;inu$s 113m.: -:!. Jstl._. -.:J,. . lrrlplIan >}S1l:m.l I StUD S "T" j.. ; l'ipillB orprivoto.-. d<Ul1l'f, S1UO 5' _. Address: ~ ~Jwn,eiteccdl..thel"" 10 feet . City. """-\"- "V^~... I Sram 1'12. 1m: '1'1fi%."1 Spocilltv Iill1I/l'CS i S19.oo S R<11lSJlCc:tl.. (n.. afhr5.x Cccpcrhr.) I Pb""<:~o{r-lK'~ ",'M. IFlllC S5a.DP S - . spaolAl ~u....a idS'peed"s Cd.. of I E.maD: ..."C'U '" ;J:'.I . " ~I.,,-, , r.-.. .1. .....roc per la-.) $6..QO S CCB Uccnst rib.: ,"oM 5 fBCOJiC1:llSiluo.:' Eodl. arld1l!...1 tupe<:1l." (1) - I ~.a.OQ S Plmnbing license nD.~ ,~p ~<o1~!ii\)"'\l~,,~~~mk~~~ iMinilmrm roo S Print\llllle:'/i;' <I^-. '1\' . . " Ent<:-vwcof_lIon BlldtlluiplOCll' sL-- Sisno=:l- ---p:~ J l!n~ucdOllID'1JlJMi.nllM'qlIiP...,j\"lU" I S ~"'5~""" ~- ~.....;[. -. . .:.; . _. ~~.. ..!. ~(I.V., .. -..' . ...... ". ~......~-~..~~. - (^) l!nla ",bI.III ahb.~_ : (Mi.imam P.....1t V.. SSUO) 1 S (lI) In.t<lIgatlv& foe I. '0 (Al) I s (C] Eillet Uy...td1otllcl.IZ x tA...8J) i s (I)) T<<MDID&Y F&c(5'loaf[AD '1 S TOT.u. r... and SUWDrg.. (A Ihn>ttrl. 0\: S ffr-b' -..> 44D-2$OO,J 1I \/IJ1ICOMl .. , SP~~~.=~ L-~~ . ~OREGON TRANSACTION RECEIPT CITY OF SPRINGFIELD 225 Fifth St Springfield,OR 97477 541.726-3753 www.ci.springfield.or.us 811'SPR2011-00163 5755 MAIN ST permitcenter@cLspringfield.or.us RECEIPT NO: 2011000365 RECORD NO: 811-SPR2011-00163 DATE: 02/26/2011 tbESCRI~i:ION""'#;":':: ,;c','''{,~iii";.T;Ziifi$!''''''''.",:i~''.b'*,:t:'2~ACCOUNfi.co6E;;;~,:~ <"~'.< AMOlJNTiDiJE. ,,' ,','. 71 Buildin~ Permit Fee 224.00000.~25602 2,947.25_.___ Fire, Life, Safety Plan Review 224.00000-425602 1,176.90 Fixture 224-00000-425603 266.00 _.~chanical Permit fee (based on valu."yf workL-..______ 224-00000-425604 355.45 Planning - Minor Review - City .......1.00-00000-425002 .______ 119.00 SOC: Improvement Cost - Local Wastewater 443-00000-446025 635.77 ___ SOC: Reimbursement Cost - Local Wastewater 442-00000-446024 1,712.36 SOC: Total Sewer Administration Fee 719-00000-426604 127.40 Sanitary sewer 224-00000-425603 76.00 Sanitary sewer: each additional 100 fe".t or portion of 224-00000-425603 36.00 State of Oregon Surcharge (1.2% of applicable fees) 621-00000-215004 441.92 Technology fee (5% of permit total) 100-00000-425605 163.66 TOTAL DUE: 8,281.73 r.::~AYMEN:-r..:.t'r.~~x:' .' ~~Ay_6R:k,'f.CA-sH1ERT'D.!l.9W~@;:;: ':\;:;~;ic.QMMENrtS~l11,;e. ".. \,;,;,,~MOLJ~TP,AID~, ;,';.;, ,,;..:::J Check CFC 8,281.73 11416 TOTAL PAID: 8,281.73