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HomeMy WebLinkAboutPermit Mechanical 2010-8-12 Mechanical Permit Application , (:\\;\,c'(, !:.'i:',S;c,;i :>i'\,:i'f': :' "iT,"', ~/lf<''' ~\".:,:1ii'i{j;l'/",-,''', .c'.~~;i ':. ',:.',7.'''''i''i.'+ '":):',DEPARTMENFUSE ONLY' ',>,.; ....'':'" .. \le,_, \!,c'!. 'C,,' ._'"'. " .,;) " ._,' ~ i.!"__,,,;"'_'.~.:.'''' .,' '. t-,~;( Cf. 225 Fifth Street. Springfield, OR 97477. PH(541)726-3753 . FAX(541)726-36S9 Permit no.: Date: If: This permit is issned 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. >f"""",,;"'0!""C'A"T'E'G"O"R"v"O-""C' ..O....N..ST. :R-.U....C. .T.-IO......N.."';'>,d ...._,. ". /:~_\t;..yl~;.~.'~~~i !~tj . ,__I!~., ., . _ \Il~l ~.r.=i~~__. _ ,~.:.. .~.' ',._ :"\;,-":.';.>~'." . "I esidentia! D Government D Commercia! :~:.(!)Jii:~.'iJoB~.si1tE';lri[F:6RMAtioNRANDr\ir6CAT:iON~W:."I:p, .'.?_.." ,,,' ,. . ......... .,. ',,"", .,.".. ,'.,. ;,". '.. .~,_ . ..'h -c.', ~ .,. ._........ _ ." ~. _. ___.,.~"..,., .. .__~ '._.. , . " ~ ., __ -'-, SO ;I. .91 \ VI ~-k..Q2. -L ~~~l~~~~~1~~tfi~;BQ.~I;Bt,~t;Q,W_N~~R~~~~~r~'f~~~~~ Name: .., ZIP: City: Phone, E-mail: This installation is being made on property owned by me or a member of my immediate family. and is exempt from licensing requirements under ORS 701.010, Signature: l1-'i~~fii,l1i1f~j<::QNJliRAc::flQR.inr{s;"I"ArrilAilil,()N:fiLJi~~~K0~i,W;1t.~,1! Bus1ness name: l City: Phone: E-mail: ~ ~;! ~ 440-2545-J (J I/OS/COM) .. .. --;-<~ ' .".-', " 'FEE SCHEDUL.E .' '" , is' .:--,!:;.';~-:,,,~:1<. ,/'j"~~-." 'GE ~-_-,;; ,> 'l"j'~>!'''- ~.~~: Qty,. ;':_ Cost ,'I;' ,.::1otal. .Resldentlal~'W~:~"",-;, ';"~'~11>: ;;~fff;eii';'-tt4t 4~c'ost';;~Ji }'<'i',.,.,,""'.... "''-''_"~c_. -.~__o~:,,""'"jt;;~ t". ;!';{':;_iy.:.(f\~~:.~.;..~ ,'~~ r._<>./.I', First Appliance J $79.00 $'Vi~ Furnace/burner including ducts and vents Upto lOOk BTU/hr. $17,00 $ Over ] OOk BTU/hr, $20.00 $ Heaters/stoves/vents Unit heater $17,00 $ Wood/pellet/gas stovelflue $38,00 $ Repair/alter/add to heating appliance/ refrigeration unit or cooling system! $58,00 $ absorption system Evaporated cooler $13,00 $ Vent fan with one duct/appliance vent $9.00 $ Hood with exhaust and duct $13.00 $ Floor furnace including vent $58.00 $ Gas piping One to four outlets 1 $7,00 $ . 1 Additional outlets (each) $4.00 $ Air-handling units, including ducts Upto 10,000 CFM $11,00 $ Over 10,000 CFM $20,00 $ Com oressor/a bsorotion svstem/heat oumo Up to 3 hp/100k BTU $17,00 $ Up to 15 hp/500k BTU $29,00 $ Up to 30 hp/l,OOO BTU $43.00 $ Upto 50 hp/l, 750 BTU $57.00 $ Over 50 hp/I,750 BTU $95,00 $ Incinerators Domestic incinerator I I $20,00 I $ <tomfjl'ercial:\9&{;it~4~~f:;<~~5'~:~~,?!_!~lt~?!'5"t1'~~~'fi~~;'!~(;~:t!~:~i(~:\~,5~;'i,!:i:;:~:?~ Enter total valuation of mechanical sy~tem and installation costs $ Enter fee based on valuation of mechanical system, etc, $ ~~li~~~D~V~~~91ft!~:~~f~~~~[~~t~~~~J~~ 'cW., 'j,\, ~l Gosf' :;,~, ")~,Total\.,', Items '~J1"""'''''~'~~' . .t,c'o"st~;:'~ ("'.'~,\<-'i'''U " .:'~,j;. ea. t;:~_-, Reinspection $58.00 $ Specially requested inspections (per hr.) $58.00 $ Regulated equipment (unclassed) $13,00 $ Each additional inspection: (I) $58.00 $ 'l'y,r"'o~~"ll'~"i!j'o,,,""'-"'''''''-' .......,~,. .....~'~'~..",,~~ ~ _(k'f:;[(01!sl'l~~#8/" ~_~~ti1t:AF,U?:CJIG~NJ~VSEi~ -j;i~}f.~*~~~;,.~~:~~lt.t1t;tW~: (A) Enter subtotal of above fees (or enter set ~ " , minimum fee of $ 79,00) $ OJ (B) Investigative fee (equal to [A]) $ (C) Enter 12% surcharge (,12 x [A+B]) $ If) :J -:l. (D) Seismic fee, 1%(,01 x [A]) $ (E) Technology Fee (5% of[A]) $ tl3~ TOTAL fees and surcharges (A through E): $ //J{) ~ dO S~RINGFIE~ k~ . OREGON WNW.ci.springfield.or.us TRANSACTION RECEIPT 811-S P R20 1 0-00045 880 21 ST ST CITY OF SPRlNGFIELD 225 Fifth 51 Springfield,OR 97477 541.726.3753 permitcenter@cl.springfield.or.us RECEIPT NO: 2010000047 RECORD NO: 811-SPR2010-00045 DATE: 08112/2010 rDESORleiliI0NlI!IIiiIlIIliIIiili'h~i';h\ii:'i:'P:\::;i~~__i5c1!J)jNIf@jllJl:liilniiPhi!Ii~ti\hhnii~\i!lil.M0UNT;rDtiElIlh~rhi!hHII"'ii" """'1 Gas Piping up to 4 outlets 224-00000-425604 $7.00 First Appliance Fee 224-00000-425604 $79.00 State of Oregon Surcharge (12% of applicable fees) 821-00000-215004 $10.32 Technology fee (5% of permit total) 100-00000-425605 $4.30 TOTAL DUE: $100.62 eAYMENTTYPE'qi:'itii\H'PAV0R\ii:ih:;\HC"tSHiEBiiiciic(;MENj'E~.Cii0~.i'lltSm !i11W\.1i"!i1(qljl({8ii:i'I'hW;J",h "'..' "'"~.~''''''''T''' ",-; , .'i\" ii" . ',"'I"AMOUNT.eAID Check' 4462 J LOGUE GAS WORKS INC $100.62 $100.62