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HomeMy WebLinkAboutPermit Mechanical 2011-6-3 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. \":'.':',.';':;~tAt~90Ry;;;1b.F?CoNstROcfION':.':',.' ',.' o Residential 0 Government Commercial 'i,}f;o.y",~ " ._~ ~~._.. "._.~-'.~'. .. -'- "d -..-..... ..-._.-- ,- "VC." . ' .. ,'.,.,. .----.-.c' .,.. "''''~-''l'''.. ." ~ii"i<'JOB\:~I:rE 'INF.'Of~JyI~:rIOI'l':Jl.ND;\If9.GATIQN.;;'\\~ .,:,[ Job site address: 11\ M. City: State: 6 e.... ZIP: "1 "n'l? IOZ~Oc::::,c::::, Taxlot.:O{ 7/7 DESCRIPTioN. OF WORK l2€a.Ac..e !7 'TO oJ. Ht::'" T S'lS~ ~:1~;~~~.~~~~t*(_'P.J{~~~RT~~QW.N'_~B~/~~~~~~~~~~~~t~~~ M~h'a~ical Permit Application )l............-.., ". ~,. ~ ..... .'u". _ .", .:r-~ ,~, '.,"j t:. . .~. '~~::''GijYioF:siRiNGF)ELi));fOREGON:.~':.-.:' -li:!$o-.'''''' ___~, ,.'-~'~1._~"',~, '-~, ._~""1'.""~0l.,. "" ".",' :.0....... ". 225 Fifth Street. Springfield, OR 97477 . PH(541)726.3753 . FAX(541)726.3689 Name: Address: ZIP: q741~ 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: ~\:J;~%~~;~,iMk9'c::iNT~AC;f:Q~~il.~~IAi!:lAflc::if'jl'A~;i';;,'.',";~,;\i i'.t-b - M. t-L AI~POrZ-"\' W,,\{ State: oF- ZIP: c/77.-s0 Fax: Print name: 5,,.... M6N'- Signature: .. ,. . 'IoU to leo,ulles . 'tili\'! \\ lal/J 90\\ U h . 0le90 Ine Ole et 10111' F>-1\t:\'oIIIO~~dO?led 'o~se !\Jles ale ~52'00~' \o\lol/J lule ce\\te!' In lou9n op-'i\ e lules '0,/ \'oIolilica\lO~.oo~ .0010 Incopies 01 I~\e,?nor.e, ill OP-'i\,;5u (\\80,/ o'otal\\'\'oIOI8" \\"e ~cli\\C"'\U\\ 090, ,0 e\\tel. \ \J\II\\'/ o caili\\9 Ine ~ne Olegog,33'2..23AA). ~'oel 101 is ~ .eO {lu,,, ce\\lel 440.2545.J (1l/08(COM) '.,.',."'';'",''__-'C: .. _~:,., ~..~,',-.,; ," -: "',,~" '; -~_"~.\""~"i" -';" ,,(>, DEPARTMENT USE ONLY'''i:<; '., . ':.-, - ....,..,. ......,',.:.'-. -", S.PRINGPIELD ~.. ~.~ ~., Date: - FEE SCHEDULE . . . ~,Be~~J#~H~~~'():~~,'~N;,,~k~t~,'t~~'\' .;, ,',~f~:l~;:,::;;~;J.;;' ,9pi, '. Cost.,. ....Total., !<';.'(ea(;!;:~\:' '':.{~~;c'ost--?>, First ADoliance $79.00 $ furnace/burner including ducts and vents Upto lOOk BTUlhr. $17.00 $ Over lOOk BTUlhr. $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 Up to 10,000 CFM I $11.00 I $ Over 10,000 CFM $20.00 I $ Compressor/absorption system/heat pump Up to 3 hpll Oak BTU $17.00 $ Up to 15 hp/500k BTU $29.00 $ .Up to 30 hpll,OOO BTU $43.00 $ Up to 50 hp/I,750 BTU $57.00 $ Over 50 hp/l,750 BTU $95.00 $ Incinerators Domestic incinerator I I $20.00 I $ :~C'ommeh:l-ar~~:~1f!:~/(::;\~9~;~~.('; ~t~~":',: ~~1f'~.:~; "Tf?~~\f.~~~;YfJ~,~~:F\~~;J : ;";; 'O.;,'t. .. Ente.r total valuatio~~fl'anical SyS~ and Installation costs 000 . Enter fee based on valuation o.f..mechanical system, etc. $ ~;M)#.9Y~~Q,~2~~~r~~~~!~~t;f4?t~~f~~*)jV~ . t.~"<.\~lj;i,\,,: COSti'~ij b~il;.i , :~.~~ <:'t_:e';~ t.." Reinspection l'l1';\'C W ~v' Specially reql"!,,~J\specliQIl,-\(ll~.?h.rr ',\<; tX~ ?$ Regulated~~qJ!pmeQtl!&Il~I~' ~~m't-\'\ . , ()\$t3.00 $ ,~ Each addition~f !!l~P,e.ttto~:: ('IQ,,;\ \S f v' $58.00 $ '''''ii!'~''!il~''''l~~'i\;''''''-''''''-';''i "'-.~-~"';m:-~ (?i~l,iXf~h~i~J.~h.;, ':,'~~ ~1?"g~IC,l(NtJ1.~t1,SEt ,J.{~',.~l!:', ~fS;i~.,ni;~;t';i: '.'I'P' .....\\.....\' r- (A) Enter subtotaLs>f.~~oye-rees (or enter set $ Jl17 ~ ~ minimum fee or.~$79.001 (B) Investigative fee (equal to [A]) $ (C) Enter 12% surcharge (.12 x [A+B]) $ 17~ - (D) Seismic fee, 1%(.01 x [A]) $ (E) Technology Fee (5% of [A]) $ 7~b ___8" TOTAL fees and surcharges (A through E): $ n7~ J. , SPRIN.,.GF"IE~ ~h_ "'-l. ~ .(l,,~. -':~ ,',"' OREGON TRANSACTION RECEIPT CITY OF SPRINGFIELD 225 Fifth 5t Springfield,OR 97477 541.726.3753 www.ci.springfield.or.us 811-SPR2011-01193 3315 MARCOlA RD permilcenter@ci.springfield.or.us RECEIPT NO: 2011001421 RECORD NO: 811.SPR2011.01193 DATE: 06/03/2011 lDES,CRIP.TION c., c. C'c ..., ". 'k ACCOUNT~CODE.r .......: .~,; 'AMOUN,tD,UE " Mechanical Permit fee (based on value of work) 224.00000.425604 147.25 State of Oregon Surcharge (12% of applicable fees) 821.00000-215004 17.67 Technology fee (5% of permit lotal) 100-00000-425605 7.36 TOTAL DUE: 172.28 LPA YMEin TYPE'. . - -PA VCR ~CASHIER: DBowLSBi:. :. ~;':'. ,COMM.~~IS. :AMOUNT.PAIl?" "" I Credit Card david casias 172.28 007155 - . - ---- -- _..-- - -~ _.. --'".- ~'----'~-"--_'_- '--'--"~""~~-'-'._-_. TOTAL PAID: 172.28