The URL can be used to link to this page

Home My WebLink AboutPermit Mechanical 2007-2-28 11 '1fl o 'j ~',i';. l\.". o ZZ5 FIrm STREET . SPRINGFIELD, OR 97477 . PH:(541)7Z6-3753 . FAX: (541)726-3689 City Job Number C 7 - ODS 0 ~ LOCATfON Of PROPOSW WORK: ,"?3.3~3 K/VIE~e.R(/fJ L)/g ASSESORS MAP: / 7 -- 0 3. 2- Z TAX LOT: /~/OO. IlfY) / , >. OWNER: /i!::""k:'/i.. h '(':.t...../. t.,.1"r) PHONE: "'? -:; '5 , 2,.,.8/7 ADDRESS: P/2DPJ~ f.?.r/PL/ifJl}A)J/i)-:, -t /)fi!"VeLIJ//JJP//J!; /23 -Z;A/7'fiZAI-11'/{)r,.V}1.. h/IiY CITY: LCJ,///6/jl/6 P; E.-L-n STATE: -.012- ZIP: q?t.!/; t', DESCRIPTION OF WORK: tIt/t~'!I2(!;AZ.O:l/ll.Jn pl!)t!w/J'!/f1)~ -tv,k, ~'r;~J? rlV?l..t/:slt1/itlJa) NEW: )( REMODEL: ADDITON: DEMOLISH: OTHER: VALUE: .' CONTRACroR'S NAME CONST. CONTRACfOR # PHONE ADDRESS EXPIRES GENERAL: T/5P ~L) PLUMBING: MECHANICAL: ELECfRICAL: rl'5b MECHANICAL PERMIT PLUMBING PERMIT ITEM FEE ITEM FEE Furnace Exhaust Hood Vent Fan No, Wood StovelInsert/Fireplace Unit Fixtures Residential Bath(s) No. Sanitary Sewer IT. Water IT. Storm Sewer IT. Mechanical Permit Subtotal **Minimum of $45.00 State Surcharge B% Administrative Fee 10% Issuance Fee Technology Fee %5 Plumbing Permit Subtotal **Minimum of $45.00 State Surcharge 8% Administrative Fee 10% Technology Fee %5 TOTAL MECHANICAL TOTAL PLUMBING --\ '~ ". "'". {i);/i'* '.: '. '.. '. l '~.;~.> ~~I ~lDll~:~Jb. ~c,...;> J>J" , ;~, ( '. ~ ' ~'> ,. '. .'. . -4. tl]~I~'" ....abn~OlWS ])hoombilllg · Shared Drive(r:)JDuildmg FonnslPennit WorksheelO8.06 doc ZON INITIALS DATE SOURCE 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-37S3 . FAX: (541)726-3689 ELECTRICAL PERMIT APPLICATION City Job Number Date -Z/;ze-/07 3. 1. '??p 3~ R/!/fe/Zk/Y'! LJ,L.~ LEGAL DESCRIPTION: A. /7- o~ '2-Z; TL /tm,: /OD,' / /00 Service Included JOB DESCRIPTION: _ .e r:::;/'k?tl 1'1' J,., 1000 sq. ft. or less ..:z:A/:;.rll/.-t-'''Vr/o.?1,' C::::;r-' r- uc... <.~ j,!'tlet':> " ,Each additional 500 sq. ft. or ftS p/f ar /Jp ;r;'lt.lt?I'J'ltrl/iC,., 1Ut~' /A,f;s4-/~lYortion thereof $106.00 $ 19.00 Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is Suspended for 180 days. Each Manufact'd Home or Modular Dwelling Service or Feeder $50.00 2. Electrical Contractor 7/3D B. Address 200 Amps or less 201 Amps to 400 Amps 401 Amps to 600 Amps 601 Amps to 1000 Amps Over 1000 AmpsNolts Reconnect Only $ 63.00 $ 75.00 $125.00 $163.00 $375.00 $ 50.00 City Phone Supervisor License Number C. Constr.C ontr. Number Installation, Alteration or Relocation 200 Amps or less 201 Amps to 400 Amps 401 Amps to 600 Amps $ 50.00 $ 69.00 $100.00 Expiration Date Expiration Date Signature of Supervising Electrician D. New Alteration or Exteusion Per Panel One Circuit Each Additional Circuit or with Service or Feeder Permit $ 43.00 $ 3.00 Owners Name Address E. City Phone Pump or irrigation Sign/Outline Lighting Limited Energy/Residential -- """'-" Limited Energy/Commercial (., ' ~ $ 45.00 Minimum Electric Permit Inspection Fee is $45.00 + Surcharges $ 50.00 $ 50.00 $ 25.00 OWNER INSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent. Owners Signature: 4. 8% State Surcharge 10% Administrative Fee 5% Technology Fee Inspection Request: 726-3769 TOTAL Shared Drive(T:)/Building FonnsIElectrical Permit Application g.06,doc CITY OF SPRINGFIELD PLUMBING PERMIT FEES TABLE 5 Peacehealth Riverbend Pneumatic Tube Annex Hospital TABLE No, 3-C REFERENCE NO, DESCRIPTION a One & Two Family Dwellings - Not Applicable b Single Plumbing Fixture c Sanitary Sewer (1) First 50 Ft. (2) Each additional 100 Ft. or portion d Water Service (1) First 50 Ft. (2) Each additional 100 Ft. or portion e Storm & Rain Drain (1) First 50 Ft. (2) Each additional 100 Ft. or portion f Sewage Ejector Pump g Special Waste Connection h Manufactured Homes - Not Applicable I Backflow Prevention Device j Relocated Structure - Not Applicable k Sanitary or Storm Sewer Cap I Any Trap or Waste not connected to Fixture m Any plumbing installation not listed in this schedule with sanitary waste or potable water supply n Minimum Inspection Fee - Not Applicable o Partial Inspection Fee (1) P Reinspection Fee (2) q Inspections Not Covered By Schedule r Inspections Outside Normal Business Hours s Investigation Fee - Not Applicable t Building Without Permit Penalty - Not Applicable u Accessible Minor Plumbing Labels NO LONGER AVAILABLE - Not Applicable v Not Accessible Minor Plumbing Labels NO LONGER AVAILABLE - NOT APPLICABLE w Hourly Inspection Fee for Requests Not In Permit Table QTY AMOUNT FEE $45,00 1 $14,00 35 $45,00 $14.00 $14.00 $14,00 10 $45.00 $490.00 $140.00 $45.00 $14.00 $14.00 $45.00 $45.00 $45.00 $45.00 $67.50 $45,00 $45.00 SUBTOTAL State Surchargel Administrative Feel Technology Feel Plan Review Feesl TOT ALl $675.00 8% $54.00 10% $67.50 5% $33.75 30% $202.50 1$1,032.75 @ @ @ @ NOTE 1: Assessment of partial inspection fees TBD NOTE 2: Two (2) inspections allowed, additional inspections required to correct deficiencies at $45,00 each at the inspector's discretion For questions please call CLAIR at (800) 383-8855 Page: 1 of 1 CLAIR No.: 1141-025 CITY OF SPRINGFIELD, OREGON 225 FIFTH STREET. SPRINGFIELD, OR 97477. PH:(541)726-3753. FAX: (541)726-3689 ELECTRICAL PERMIT APPLICATION City Job Number lEGAL DESCRIPTION JOB DESCRIPTION Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is Suspended for 180 days, 2 Contractor Address City Phone SupeNisor License Number Expiration Date Constr, Contr. Number Expiration Date Signature of SupeNising Electrician Owners Name Address City Phone OWNER INSTALLATION The installation is being made on property I own which is not intended for sale, lease or rent. Owners Signature: Inspection Request: 726-3769 TOTAL Pneumatic Tube and Fiber Ducts 3. A. A. New Residential- Single or Multi-Family per dwelling unit. Service Included 1000 sq. ft. or less. $106,00 Each additional 500 sq. ft, or portion thereof, $19.00 Each Manufact'd Home or Modular Dwelling SeNice or Feeder $50.00 B. 200 Amps or less. $63,00 201 Amps to 400 Amps. $75.00 401 Amps to 600 Amps. $125.00 601 Amps to 1000 Amps. $163.00 Over 1000 AmpsNolts. $375.00 Reconnect Only. $50.00 C. Installation, Alteration or Relocation 200 Amps or less. $50.00 201 Amps to 400 Amps, $69.00 401 Amps to 600 Amps, $100.00 Over 600 Amps or 1000 Volts see "B" above, D, New Alteration or Extension Per Panel One Circuit. $43.00 Each Additional Circuit or with SeNice or Feeder Permit. $3.00 E. Pump or irrigation. Sign/Outline Lighting. $50.00 Limited Energy/Residential. $25.00 Limited Energy/Commercial. 1 $45.00 $45.00 Minimum Electric Permit Inspection Fee is $45.00 + Surcharges 4. $45.00 8% State Surcharge $3.60 10% Administrative Fee $4.50 5% Technology Fee $2,25 25% Plan Review fee $11.25 TOTAL $66.60 225 FIFTH STREET. SPRINGFIELD, OR 97477 . PH:(541)726-3753 . FAX: (541)726-3689 Date 217...a101 / tJ Demolition o Other City Job Number o 1 & 2 Family Dwelling or Accessory --gl New Construction o Mnlti-Family 0 Addition/Alteration/Replacement 'xr CommerciallIndustrial 0 Tenant Improvement Job Address 335::3 F/ )I/Z.Ie/2;e',vI) DR.' Lot Block Subdivision Project Name ,.g #/'P/'< AP.J'tl[) Description ofWorkJlocation on premises/special conditions e...l t..;f /i I -rent>. P/;'u,), t.Del/t;;t.. I r . - Mailing Address 12:=:' :J;..1'1J1~tfllV.A'1' ?tll1!i1. 'lAltt City ,::l,PI;}../ )()IJPr.t.~ State (:)It. Zipq'?'!71 Phone "'8~ 5 z"EL7 Fax t,fjrl 3",$'0 Owner Representative ~ ~ A,.f'.t?~' Phone ~~ ~8/7 Fax t::..""a J ~"-'~z;> o o Name ;:!)AA?(! Mailing Address City Phone State Fax Zip o Name K PPF Address , t I "5 W 5112 /lHvJ "f5ili;~ Z~ City '"Po/L:T t.....1 A)IO State of. \ Zip 172 e// Contact Person j/VLM!:e./A/ rILP../.lbt,f/"I'tJI') Phone '505\'.. 304 ;Z.;::t:,9.\ 0 7 Fax o Bldg No. Suite No. Tax Mapffax Lot /7 -/)3 - 2"2 7t- /b(;'t?) /tlCi/ I/O() ~/r:;I",I.J')'}.Ii/~ 'tr.;jA{ ~ r,l~,,~f. dt/.,t." SQFt x $/SQ Ft Value New Dwelling Area Garage/Carport Area Other Structure Area Total Value SQ Ft X $/SQ Ft Value Existing Building Area New Building Area Total Value Existing New Occupancy Group(s) Const. Type(s) Number of Stories General Plumbing Mechanical Electrical Contractor's Name -rU4.iJJleJ2.. (hH61. ~ ""I'""JCl..T) -r p., 11 CCB# /69t:?86 Expiration Date Phone # // It? /t77 s-7") '1~.,"1z. t/l) I , ~- _ ~ Jel ~~lj&'i![1I1~.._~RI.lIJ~1~1 0 Has site review application been submitted? Heat Source: Primary Secondary ~ Yes 0 No 0 N/A ~ Water Heater Range Energy Path Ifso, Name of Planner .,I../JI.JQ4l?itdt.l Do you require any of the following for this project? Journal Number p# 200(;;.. Oa6h Over-width or Second Driveway 0 Yes 0 No Temporary Power 0 Yes 0 No Notice: All contractors & subcontractors are required to be licensed with the Construction Contractors Board of the State of Oregon under rovisions ofORS 701 and may be required to be licensed in the 'urisdiction where work is bein performed. 1 RCPT# I PERMIT PLAN CHECK FEE I BUILDING r DATE I I BY I APPLICATION Shared Orive(T:}lBuilding Fonns/Building Pennit Application lO-02,doc Property Planning & Development 123 International Way, Springfield, OR 97477 Phone 541-868-3505 Fax 541-335-2595 PeaceHealth Oregon Region Letter of Transmittal I To: Clair Company, Inc. 3333 Game Farm Road Springfield, OR 97477 Allan Clair 2/28/2007 Job No: Re: RiverBend Sacred Heart Medical Center Underground Pneumatic Tube and Fiber Ducts Attn: Date: We Are Sending You: D Shop Drawings o Copy of Letter [8] Attached o Under Separate Cover DSUbmittal o PrintS Gopies 1 1 1 3 Date No. Description I Permit. Worksheet I Building permit Application I Electrical Permit Application ISets of P-tube Plans I I I These Are Transmitted as Checked Below: DFor approval DApproved as submitted DApproved as noted o Resubmit _ copies for approval DSubmit _ copies for distribution DFor your use DAS requ'ested DReturned for corrections DReturn _ corrected prints DFor your review and comment EjOther Remarks: For you review and approval in issuing a limited energy and plumbing permit as we have discussed: Thahks, Copy To: . Signed: Chip Moulds 3/1/2007