HomeMy WebLinkAboutPermit Mechanical 2011-7-7
07/07/~211 08:33
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5416885816
Mechanical Permit Application
en)' OF SPRINGFIELD, OREGON
22. Filii> S_ . SVringfldd, OR 97477 . Pll(S41)726-3753 . FAX(541)n6-J689
J co HEATING
PAGE 01/01
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Permit no.:
Date:
TIIis ponait is issu.d undeT OAR 91~OO50. Permits e~pl...lfwoTk is not .tarted witblD 180 days oflssu8n<o or jfwork is
.uspended ror 180 days.
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Sign.ture:
440-;2545-) (l1108ICOM)
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First A liance
urnacelburner iaduding duds aad nnts
Up to lOOk BTUIbr.
Over lOOk BTUlhr.
Heat.n/.toves/v......
Unit beater
WoodIpeUeVgas stov<lfl..
Rc:paitfaltel'/add to tang app Ian
refri.geratiQp u.o.it Qt cooling symml
absorption sysbml
Evaporated cooler
Vent fan with on!;: duct/appliance vent
Hood with exboust and duct
Floor ma<:e including vent
Gas i jog
One to four outlets
Additional outlets (each)
Air-boodling uoita, ineludin
Up to 10,000 CFM
Over 10,000 CPM
Com ressor/absor tioo s
Up to 3 bpllOOk BTU
Up 10 15 bI>'5OOI< BTU
Up to 30 .pll,OOO BTU
Up to 50hpll,750 Bnl
Over 50 hpl!, 750 BTU
Incinerators
Domestic incinerator $
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Enter total valuation of mechanical system
and installation costs S
Enter tee based on valuation ofmecbaniarl Sfstelr4 etc.
$17.00
$20.00
$
$
$17.00
$38.00
$
$
$68.00
$
$'3-00 $
$9,00 $
$13.00 $
$S8.00 $
$
$
$
$
$'7.00 $
$29.00 $
$43.00 $
$S7.oo $
$9s.o0 $
$
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.:!~~~L~~~~~:";:;::;:;;,,i:ii~(~k~gt!im1~!im~~~~ ~.~~~: ~~:t,~it!:1!~~~ ;~~l'~~i~i~::
$58.00 $
$58.00 $
$13.00 $
$58.00 $
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(A) Ent<:.r sublo1al of above file$ (or enter set
minimum fee of S 19.00t
(B) Iovostigllt;vo foo (equal to lAD
(C) Enter 12% surohorgo (.12 x (A+B])
(D) Seismicree, 1%(,01 x [A])
(E) Tocbnology Pee (5% of (An
TOTAL rees and surobarge. (A through E):
-;.:~!~
$
$
$ . 5
$ (\C}, 'A'b \)j\
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t;,."...
SP.~IN G,:'I~.lD
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.. delL OREGON
TRANSACTION RECEIPT
CITY OF SPRINGFIELD
225 Fifth St
Springfield, OR 97477
541-726-3753
WWN.ci.springfield.or.us
811-SPR2011-01652
5335 MAIN ST, SPACE 205
permilcenter@ci.springfield,or.us
RECEIPT NO: 2011001917 RECORD NO: 611-SPR2011-01652 DATE: 07/07/2011
lOESe.RUnION' -,".+'/:,'" t,"'~ F' 0'5,! if'; " '" v, ""> ,','Aee'o.UiIlf:tcOOE: , , = "';'AMO,UNT_O:UE".z,'1
First Appliance Fee 224-00000-425604 79,00
State of Oregon Surcharge (12% of applicable fees) 621-00000-215004 9A6
Technology fee (5% of permit total) 100-00000-425605 3,95
TOTAL DUE: 92,43
: .,PA.YMENT TYPE, -.,PAYOR.-:">:c"sHIER:ccARPENTER,:;:coMMENTS?€'~" ,,:'- ,', . ",' . .'tAMoUN'TpAID '. ,.' 'I
, '....... -~~~.. .~'-"'~~_...._~------~-~ .., ~
Credit Card J COO INC Brian Tiller By Phone $92.43
059365
TOTAL PAID:
$92,43