HomeMy WebLinkAboutPermit Mechanical 2011-6-3
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Mechanical Permit Application
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.'r",'~~Ciiy'6FSPRINGFIE'L1),' OREGON ."-
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225 Fifth Street. Springfield, OR 97477 . PH(541)726-3753 . FAX(541)726-3689
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Permitno: SI/-O J 3>S' 7
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Date:.b ~ / I
This permit is issued under OAR 918~440-0050. Permits expire if work is not started within 180 days ofissuance or if work is
suspended for 180 days.
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Commercial
'. . :;.:;.::~2.:BRbf1ERTY,bWNER';.
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Address: " -f to i-J r
City: S ,'~ I J State: CI\
Phone: 5V/- ,z.(.-IJt<
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:
'l\~l;'f'i.::,.;.',i ;CONTRACibR :jN~lALLATr6N~\':;:;h:
Business name: 6.e.. A - C Qo .." ~ II\. C _
Address:\>::' Qo.}< 2.~ r.r J
City: '"? c. r tl., State: 01\ ZIP: '1)21 b
Phone: g'()3 -z..li5-'lJ) Fax:S",;'Z4S.,I.S)
E-mail: e..lCo...lS..l..~. e "Ill. '-,......
CCB license 'no.: 5:..r Bi: 0
Print name: ( ~ + .... ) '-'C.".)-'" '"^-_
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ZIP: '1 ') (..0)
Signature:
{Jg \; \ :'; G g - ll2 ~\l;les 'jo~\\~\'I
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. o\e<00~ '0'1 \\;\e \eS 'iJ.\e S~'2._QCl\'
'(:.~IIO~\c\O?\B I\;\Ose l\l \;\ O!'-t'- 9 1\lleS '0'1
!,-II tu\eS l\\Bl. \\;\10\l<0 0\ \\;\e ol\e
\0110'" \01' Ce _ClCl\Q o?\eS \Ble?\;\ \101'
~o'i.\\IC'iJ.\S'2..QQ\ 0'0\'0.11' ~o\e" \\"Ie ~o'i.I\IC'iJ. \C~.
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ll''Oe\ l\\Bl IS \>.1.) \
440-2545.j (I1108/COrO~ ce (J\)\~\\j\
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"":. '.
I ~e~ideni;al . .'
First Appliance
r<'urnace/bu."ner including ducts and \-'eots
'FEE SC:HED\JLE'
". "y"'j' .
" '.' Qty.,
'f "" ,""
,."":
C~st ~ :, ,Total
~ca. \ i:' cost
$79.00 $
Up to lOOk BTU/hr.
Over lOOk BTU/hr.
Heaters/stoves/vents
Unit heater
I $17.00 $
$20.00 $
$17.00 $
$38.00 $
$58.00 $
$13.00 $
$9.00 $
$13.00 $
$58.00 $
Wood/pellet/gas stove/tlue .
Repair/alter/add to heating appliance/
refrigeration unit or cooling system!
absorption system
Evaporated cooler
Ven( fan with one ducUappliance vent
Hood with exhaust and duct
Floor furnace including vent
Gas piping
One to four outlets
I
Additional outlets (each) I
Air.handling units, including ducts
Up to 10,000 CFM '$11.00 I $
Over 10,000 CFM I $20.00 I $
Comoressor/absorotion system/heat DUffiD
Up to 3 hp/JOOk BTU $17.00
Up to 15 hp/500k BTU $29.00
Up to 30 hp/J,OOO BTU $43.00
Up to 50 hp/l,750 BTU $57.00
Over 50 hp/I,750 BTU $95.00
Incinerators
Domestic incinerator I $20.00 I $
'C:oiTl'inercial' ..- .... ':':"'<;J'.:';,!f".'''i~\'''.' ':0::. . ;.:,
$7.00 I $
$4.00 I $
$
$
$
$
$
,i:f;::tl,,~:.1
Enter total valuation of mechanical system
and installation costs $ "O.s.- (). ~.
Enter fee based on val!Jation of mechanical system, etc, $
: ( " . ~'.' ,::-... :'1 '.ft: r.... ',. ".<
~ Misc'ellaneou's'tees,';
"",",,". ".-" ,~;...,', ...." ',""ii,., .,'1.
Reinspection
," I.,,'
. "Ir' .;
Specially requested inspections (per hr.)
Regulated equipment (unclassed) .
Each additional inspection::(i)
.. ~ost,;'. - }:~.t~,1 OJ:!;:
ea...,,~ ,I' :,cost ~,
$58.00 $
$58.00 $
$13.00 $
$58.00 $
. . ,: ,., y." ",;1,.,
o , ,i):' d,:':',J1i-'~:l",<I., '.
$J27iS-
$
$ /.5-'#l
$
$ [, > ,
$ /4 ?!,7
Items
,i
:\~ ~1";j(~'i~~:,:~,j:~"';t::",::,'j'i~AP ":' or SE
(A) Enter subtotal R!:~'JI;:Yi<~(\lee cr set.
minimum fee<9ilI$~9!Il"o.\l\ . <f\?- ,".
(B ~",,'I\i\;:febu.l,tll;.!AJ).
:1t, i'l\'\'ii~s;~~.i~(.12x[A+iJ])
:tb e1l'W\;'l8:~' %(.01 x [A])
lIt/) . "'t!!1!~)l-I'ee (5% of [A])
'~(I;&).'L fees and surcharges (A through E):
.;
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www.ci.springfield.or.us
TRANSACTION RECEIPT
811-SPR2011-01357
3033 GATEWAY ST. APT 1
CITY OF SPRINGFIELD
225 Fifth St
Springfield,OR 97477
54'-726~3753
permitcenter@ci.springfield.or.us
RECEIPT NO: 2011001516 RECORD NO: 811-SPR2011-01357
~QESCRI~tI6N~":~:; "';~; ,,;d: ~,' ,-'7'~.:';;:2;;~;':.~:L...:;l\cc6t.JNT!CODE: ,. - .
Mechanical Permil fee (based on value of work) 224-00000-425604
State of Oregon Surcharge (12% of applicable fees) 821-00000-215004
Technology fee (5% of permit total) 100-00000-425605
TOTAL DUE:
DATE: 06/09/2011
, d:"::!:AIVIOUNTj:iDE:._:'__....;.
127.75
15,33
6,39
149,47
f ,PAYMENTnPE' ':' """PAYQ.~Y?-;~ASHiER,oB6I1iLSBy;:~A'j'i-f:;\g.qMJ\IIE1:r:f.1l'f\~f;;+;:;J:.'''1' ",?' ;.tAMOUNTcFIAII?:":;:i(;;:~~
Credit Card brent gunderson 149.47
008112
TOTAL PAID:
149.47