HomeMy WebLinkAboutPermit Mechanical 2010-11-17
6-'10 13:56 FROM-Kevin Cohen Plumbing
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5416077033
T-365 P001/003 F-915
225 tifth'S\r.ci . Springfield. OR 91417 . PH(541)726.3753 . FAX(541)726-3689
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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
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:.:~ 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