HomeMy WebLinkAboutPermit Mechanical 2011-4-14
Mecllanical Permit Application.
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225 FiftbStreet . Springfield, OR 97477. PH(541)726-3753 . FAX(541)726-3689
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Date:
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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 un er S 701.01 .
Signature:
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,Business name:
Address: 6 C b
City:
Phone:o
ZIP '1 7t(oZ-
Print name:
Signature:
NOTICE: 'E \F THE WORK
THIS PERMIT SHA~~ ~~~ PERM\I IS NOT
AUTHORIZED ut~D S ABANDONED FOR
COMMENCED OR I
ANY 180 DAY PERIOD.
440-2545-) (11/08/COM)
7
" ."." FEE SCHEDULe' ",
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~B~!.L~~:~J!~Xi~~;~g~~~R~f~::;;~~~~,i~ffJ:]\ QtY;: \.:-Cost:-;" ,,',Total,
,'~ 'k~':~' f:~ifea':~~~'!.. 4;rfrcost::i:.~"
First Aooliance $79.00 $
urnace/burner including ducts and vents
Up to lOOk BTU/hr. $17,00 $
Over lOOk BTU/hr. $20.00 $
Heaters/stoves/vents
Unit heater $17.00 $
Wood/pellet/gas stove/flue $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 $7.00 $
Additional outlets (each) $4,00 $
Air-handling units, including ducts
Upto 10,000 CFM I I $11.00 I $
Over 10,000 CFM I $20.00 $
Comnressor/absorntion system/heat Dumn
Up to 3 hp/l OOk BTU $17.00 $
Up to 15 hp/500k BTU $29.00 $
Up to 30 hp/l,OOO BTU $43.00 $
Up to 50 hp/l,750 BTU $57,00 $
Over 50 hp/l,750 BTU $95.00 $
Incinerators
Domestic incinerator ~". I $20.00 I $
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Enter total valuation of mechanical system
and installation costs $
Enter fee based on valuation of mechanical system, etc. $
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,: ,1"-'.:_, ~ ,"' ' __~cost.~<~~
Reinspection $58.00 $
Specially requested inspections (per hr.) $58.00 $
Regulated equipment (unc1assed) $13,00 $
Each additional inspection: (l) $58.00 $
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(A) Enter subtotal of above fees (or enter set
minimum fee of $ 79.00) $
(B) Investigative ree (equal to [A]) $
(C) Enter 12% surcharge (.12 x [A+B]) $
(D) Seismic ree, 1% (.01 x [A]) $
(E) Technology Fee (5% of [A]) $
TOTAL rees and surcharges (A through E): $
TRANSACTION RECEIPT
CITY OF SPRINGFIELD
225 Fifth 8t
Springfield, OR 97477
541-726.3753
www.ci.springfield.or.us
811-$PR2011-00604
885 25TH PL
permitcenter@ci,springfield.or.us
RECORD NO: 811-SPR2011-00604 DATE: 04/14/2011
,~''''~'i'; "';'!~''';'W$;'';;'l.:,; 'li.'i"AcCOOtn;C6'DE~' " ., - 'AMQUNT.DUE ~,
224-00000-425604 79,00
821-00000-215004 9A8
100-00000-425605 3,95
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TOTAL DUE: 92,43
l,F~~Y.M~JJYPE,.,:~:~4Y_OR:';CAS'HIER'NMACHAbo""t~;~,-;':lC.QMMEi!~.sr;(; "'~. ",.;. '^AMqUNTl"AltE ;-
Cred!I Card Anthony Brown 92,43
029138
RECEIPT NO: 2011000722
lDESCRI~tI6N" "",~:,'..- ii" F' ,,-
First Appliance Fee
State of Oregon Surcharge (12% of applicable fees)
Technology fee (5% of permit total)
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TOTAL PAID:
92.43