HomeMy WebLinkAboutPermit Mechanical 2009-2-20
225 Fifth Street. Springfield, OR 97477 . PH(54I)726-3753 . FAX(541)726-3689
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I - DEPARTMENTUSE ONLY
I Permitn~.: c.?- 00 ZZ- I
I Date: Z- 2-0 -0 '1
Mechanical Permit Application
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. .
I I.....
. I~Reside~tial 1 0 Gove. ffiment I OcommerCial.' .'ReSidential '1 Qty.1 ~
I JOB SITE (NFORMA TION AND LOCA nON. I First ADDliance I 579.00
I)Obsiteaddress:LJ':2...2!,.<' FfANkL! M 8 LV D.7IZh Furnac:elbumeriocludiogductsaodveuts
1 City: E L{ C. E tJ C I State:, D It I ZIP: <; 7':1'0.3 'I Up to lOOk BTUIhr, I i
I I Over lOOk BTUIhr,
Subdivision: Lot no,: I H' rsI esIv
'1 eate stov eots
I DESCRIPTION OF WORK I Unit heater
I /n,<t",}{ e./ e0+ f',' (' +' CJ r,.., Q." e..- I 1 Wood/pellet/gas stove/flue
I I Repair/alter/add to heating appliance!
refrigeration unit or cooling system!
, PRO..t:,,,,' OWNER absorption system
IName: ^' AT /:fA,v H t'l P J-.IfV I Evaporated cooler
I Addres;: 4?9" FII..AN kLIN /3,L VD Vent fan with one duct/appliance vent
I Hood'with exhaust and duct
1 City: E- U G-8rJ ~ I State: f!) J(. I ZIP: q" '/ ~ 3
~ '" I Floor furnace including vent.
'1 Phone:,,-LH'ic"'/ 'J./ / ';.:1.. I Fax: I I Gas pipinl(
I E-mail: I . I One to four outlets
This installation is being made on property owned by me or a I Additiooal outlets (each) I
member of my immediate family, and is exempt from licensing I Air-baodlinl( units, includinl( ducts
requirements under ORS 701.010, . I Up to 10,000 CFM 1 $11,00 I $
Signature: lOver 10,000 CFM 1 \ $20.00 $
I CONTRACTOR INSTALLA nON I Comoressor/absorntioo svstemlbeat pump
I ' . I Up to 3 hpllOOk BTU I. $17.00 1 $
Businessname:ALL FP.'mIJ-'/ HE'Alfl0C-
I ,. I Up to 15 hp/500k BTU I $29,00 I $
, Address: / '1:~b Ht:>w A 11../) . ~T: <s G I
Up to 30 hpll,OOO BTU I $43.00 I $
ICity".sAJ..'~m '1 State: OR IZIP:'t?3o~lluPt050hp/I,750BTU I $57.001$
1 Phone:oO::~ 39"'l l1<.3~8 I Fax<.5a3 &3 "ft.If I Over50hp/I,750BTU I $95.00 '$
I E-mail: 'I Incinerators
I Domestic incinerator
1 Commercial
I I;:o. ter total valuation of mechanical system
and installation costs $ ~
I Enter fee based on valuation of mechanical system;etc. ,I $
I Miscellaneous fees ' . ptermj c:: I ~:I
I Reinspection I I $58.00 I $ I
1 Specially requested inspections (per hr.) I I $58,00 I $ 1
I Regulated equipment (unclassed) I 1 $13. .00 I $ I
1 Each additionalinspe<tion: (I) 1 I $58,00 $ I
I APPLICANT USE . J
I (A) Enter subtotal of above fees (or enter set . I
minimum fee of $ 79,001 . $ '792
I (B) Investigative fee (equal 10 [A]) ... $.
I (C)EnterI2%surcharge(.12x(A+B]) $ 9 '1.01
I (0) Seismic fee. 1%(.01 x [A]) I $ /. '/9
I (El Technology Fee (5% of[A]) 'J $ iLl t...",
I M"~""'."~~(""~'0.?~3
L
CATEGORY OF CONSTRUCnON:,
FEE SCHEDULE
$17.00 I
$20.00
I
TOWJ
$;; .
I
$ I'J =1
$ I
$17,00
$38,00
$
$
$58.00
$
$13,00 $
$9.00 I $
$13.00 I $
$58.00 I $
I,
I
$7,00 I $
$4,00 I $
CCB license no.:' ) 7 i 1'-<,? I
Print name: AAJO R EA 0,; 1'1) f\ R ~ "
I Signature: 0 ^ ' n, ^ ~ F1 rn
...~ rV_ ".~ o,{). J' (A Jl....f'Jl
,
$20,00 I $
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440.2545-) (l1/OS/COM)
225 Fifth Street
Springfield, Oregon 97477
541-726-3759 Phone
Job/JournalNumber
COM2009-00221
COM2009-00221
COM2009-00221
Payments:
Type of Payment
Check
cReceintl
- RECEIPT #:
Description
151 Appliance
+ 5% Technology Fee
+ 12% State Surcharge
Paid By
ALL F AMIL Y HEA TfNG AND
COOLiNG
'--
,
City of Springfield Official Receipt
Development Services Department
Public Works Department
1200900000000000133
Date: 02/26/2009
Item Total:
Check Number Authorization
Received By Batch Number Number How Received
KR' 1981 By Mail
Payment Talal:
Page 1 of I
8:46:24AM
Amount Due
79,00
3,95
9.48
$92.43
Amount Paid
$92.43
$92.43
2/2612009