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HomeMy WebLinkAboutPermit Mechanical 2010-11-17 6-'10 13:56 FROM-Kevin Cohen Plumbing RICHI renllll .a...IJIU;UllUU 5416077033 T-365 P001/003 F-915 225 tifth'S\r.ci . Springfield. OR 91417 . PH(541)726.3753 . FAX(541)726-3689 no~/~<rs7Z. 7 Date: - ( 7 - ( 0 This permit is issued under OAR 918-440-0050. Permits e..pire if work is not started within 180 days of issuance or if work is suspended for 180 days. CATEGORY.OF CONSTRUCTION FEE SCHEDULE o Residential -, 0 Governmenl lIE Commercial Residential Qty. Cost Total ea. co.!!t JOB SITE INFORMATION AND LOCATION first Aooliancc $79.00 $ Job site address: Ilon'.'\ hi ELL!; Y 51 Furnace/burner including duct$: and vents City:SPR.liJG r:-:fJ:"l-l? I Slate: Of I ZIP: 0)7'07 Up to lOOk BTUthr. $11.00 $ Over lOOk BTUthr. Ret"erence: II',...} I ~ r1....+ I Taxlol.: $20.00 $ Heaters/stons/vents r ,^~2700DESCRIPTION Of WORK 009/',7 Unit heater $17.00 $ W"..+e_ t, -<"~./..c...- '^-<" ..1. r-" ..l- J Wood/pellet/gas stove/flue $38.00 $ lA(Cr>r'~ /-"..1 . ""0'5' "''-"".;,~ Repair/alter/add to heating appliance! refrig~rution unit or cooling s:ysteml $58.00 $ PRO'PERTY' OWNER"' absorptjon system Name: U0-~ '" 1..1"'- .K". l /""J'-h "- Evapor~ted cooler $13.00 $ Address: {, Y 0 0 SW coflbe--IJ- :" <1..- Ven,t fan with ont duct/appliance vent $9.00 $ Hood with exhaust and du(:t $13.00 $ Ci1y: Pon-l~-...ol I Slate: () [I.. I ZIP:Cf 71.1 q Floor furnace including vent $68.00 $ Phone: - - I Fax: - . Gas pipinl! E-mail: One to four ooUets I I $7.00 I $ This installation is being made on property owned by me or a Additional outlets (each) I I $4.00 I $ member of my immediate family, and is exempt from licensing Air.bandlinl! units, including duels requirements under ORS 701.010. Up to 10,000 CFM I $11,00 $ Signalure: Over 10.000 CfM I $20.00 $ CONTRACTOR INSTALLATION Comnressor/absorntion svstemlbeat pump Business name: /( ,. v 1'......... (',., L.".:... ?I u-r---h / :.... ~ Up 10 J hptl OOk BTU $11.00 $ Address: lj -) ~ ( tZ" ~I II-v e #="1 S- -'" Up to 1 S hp/500k BTU $29.00 $ Up to 30 hptl.OOO BTU $43.00 $ ( I State: I'J f2 I ZIP: '17 '-102- City: EUrl. "",e; Up to 50 hptl,7S0 BTU $57.00 $ Phond'll':({j7.;::q-"tO~----' -I' Pax:S"'l(:.{{Jr?tJ"'C?_ Over 50 hp/l.750 BTU $95.00 $ (m:aC:./JJPO (6;) Ke\l,."'Gj.,~"f/vv-b--.Cor-................ Incinerators CCB licen;e no.: 77 6"3 If Damestit; incinerator I I $20.00 I $ ---. Print name: GOI,V'c. it LOnro,ef! Commercial Enter total valuation of ?~hanica~s:tem ~ and installation cosl' $ .0, 0 Signature: .J- ~ Enter fee based on valuation of mechanic:al systcm, etc. $ / Miscollaneous feell Items Cost Total ea. cost Roinspection $58.00 $ Specially requested inspections (per hr.) $58.00 $ ATTENTION: Oregon law requires you to Regulaled equipment (unclassed) $13.00 $ follow rules adopted by the Oregon Utility Ea~h additional inspection: (I) $58.00 $ Notification Center. Those rules are set forth APPLICANT USE in OAR 952-001-0010 through OAR 952-001- 0090. You may obtain copies of the rules by (A) Enter subtotal of above fees (or entcr set cailing the center. (Note: the telephone minimum foe of $ 79.00) $ number for the Oregon Utility Notification (B) Investisative ree (equal to [A]) $ Center is 1-800-332-2344). (C) Enter 12% suroharge (.12. [A+B)) $ . ~Ol\CE: . )(.pIRE II: 1\1E \j \i::ijSeismic fee. 1% (.01. [A]) $ THIS PEPS.JiIT S\1i\LL ;'HIS PERMIT \~ ~R)hIechnology Fee (5% orrA]) $ . 44M545-] (I liDS/COM) i\UTHOR\2ED UNDER Bi\NDONED FOjRrOTAL r... and surcharges (A lbrough E): $ <I~~ i:> COMMENCED OR IS A ~ ~, ANYi80 DAY PERIOD. V I ~6 '> - SP. RIN..G. f.I~~ ..~,!-,., <!:'. ,~ :.:~ OREGON www.ci.springfleld.or.us TRANSACTION RECEIPT 811-SPR2010-00727 1100 SHELLEY ST CITY OF SPRINGFIELD 225 Fifth St Springfield,OR 97477 541.726.3753 permitcenler@ci.springfield.or,us RECEIPT NO: 2010000850 RECORD NO: 811-SPR2010-00727 DATE: 11/17/2010 I bESCRIPTION':!:f'~';;_. Water heater Balance of Minimum Plumbing Permit Fees Mechanical Permit fee (based on value of work) Slate of OreQon Surcharge (12% of applicable fees) TechnoloQY fee (5% of permit total) om 'F:~C '::~':"-""T:#.'~C%Rr:~j~.t~{;:~:::t~r.Lf '.f\~~.G.~~,Nj~g9~Q_e~;~ <:0 ~<r c~;. ANlOU NT Dyg:'w' (':.j' , ,7 224-00000-425603 $19.00 224-00000-425603 $39.00 224-00000-425604 $254.50 821-00000-215004 $37.50 100-00000-425605 $15.63 TOTAL DUE: $365.63 PAVMENT'TYf'E \. . pAVOR. : '.:cAsfiIERDBQ.0iLS~Y :' ., (;.Qll'ir:-U;t-jI$" .,,::~_;:! _:''':''::~~M.q.!J.N:rPA1D_:~_~~:''..:5 'I Credit Card b66745 KEVIN COHEN PLUMBING INC $365.63 $365.63