HomeMy WebLinkAboutPermit Mechanical 2019-06-19?Mechanical Permit Application
225 Fifth Street o Spnngf eld,OR97477 ) PH(541)726-3753 . FAX(541)726-3689
This permit is issued 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.
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Permit no.
Date n
E Government fl CommercialE Residential
Job site address: I l2+ 57$ Si.
City: (.,.-1r,,f State:1)p zw: Q 74 Tg
R"f"."r'rJ"l Taxlot.
Name: Lg*
Address: /[of, 7O2
ztP: 9 Vl7 yCity: 9..r1)State: Qp
Phone: iA, - ftt -ro.rz Fax: 7C -
E-mail: 1
701
meora
licensing
Signature:
This installation is
member of my
requirements
made
Business name
Address:
State NPCity:
Phone:Fax:
E-mail:
CCB license no.: lll-lQQ
Print name
Signature
Residential Total
rost
First Aooliance s99.00 $
Furnace/burner includinq ducts and vents
$22.00 $Up to 100k BTU,rhr
$25.00 $Over 100k BTU,rhr
Heeters/stoves/vents
s22.00 $Unit heater
Wood/pellet/gas stove/flue ss2.00 $
$18.00 $Evaporated cooler
Vent fan with one duct/appliance I s13.00 $
$18.00 $Hood with exhaust and duct
s8.48 $One to four outlets
Additional outlets (each)$s.30 $
ducts
$15.00 $Up to 10.000 CFM
Over 10.000 CFM s25.00 $
Comnressor/absorotion svstem/heat oumn
$22.00 $Up to 3 hp/100k BTU-.
Up to 15 hp/500k BTU $40.00 $
ss9.00 $Up to 30 hp/1,000 BTU
$Up to 50 hp/1,750 BTU $76.00
Over 50 hp/1,750 BTU $r 28.00 $
Incinerators
Domestic ilcinerator $25.00 s
Enter total valuation ofmechanical system
and installation costs $
$
Total
eost
$
Enter fee based on valuation ofmechanical
s99.00
etc.
s99.00 $Specialll' requested inspections (peI
Regulated equipment (unclassed)$18.00 $
(A) Enter subtotal ofabove fees (or enter set
Each additional on: (1)$99.00 $
sminimum fee of $
(B) Investigative fee $
$(C) Enter 127o surcharge (.12 x [A+B])
$(D) Seismic fee. 1o/o (.01 x [A])
(E) Technolog-r' Fee (57i, of [Al)$
$ lLe -vTOTAL fees and surcharges (A through E):
Iast edrted 7/1/201 8 bjones
CATEGORY OF CONSTRUCTION
JOB SITE INFORMATION AND LOCATION
DESCRIPTION OF WORK
:PROFERTY OWNER
{oNrn*tToRTTTALLAT}IIN
DEPARTMENT USE ONLY
FEE SCHEDULE
Uost
ee-
Commercial
eost
m-Miscellaneous fees
Reinspection
DEPARTMENT USE