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HomeMy WebLinkAboutPermit Plumbing 2014-3-24 (2) Plumbing Permit Application DEPARTMENT USE ONLY :.. - . r. ;.t:ij Permit no,: /W —225 fifth Street ♦ Springfield.OR 97477 • P11(541)726-3753 ♦ fAX541)7263639 -\ OREGON Date: 3/2 cf// This permit is issued under OAR 918-780-0060. Permits are issued only to the person or contractor doing the work. Permits expire if work is not started within 180 clays of issuance or if work is suspended for 180 clays. LOCAL GOVERNMENT APPROVAL FEE__SCHEDULE Zoning approval verified? ❑ Yes ❑ No Description Qty. �uasf j cot Total Sanitation approval verified? ❑ Yes ❑No New residential CATEGORY OF CONSTRUCTION I hathroonl/I kitchen(include.e:Jirst 100 feet of wafer/sewer lines, hose gi Residential ❑ Government ID Commercial Gibs, ice maker. underfloo•low-point $262.00 $ JOB SITE INFORMATION AND LOCATION drains awl min-drain packages) Job site address: 3333 M404o-caJ 9arabet . 2 bathrooms/I kitchen $411.00 $ City: c Pat t.16eetp State: 0/L ZIP: 97Y77 3 bathrooms/1 kitchen $483.00 $ Each additional bathroom(over 3) $104.50 5 . Reference: Taxlot.: Each additional kitchen(over I) $104.50 $ DESCRIPTION OF WORK Residential lire sprinklers(includes plan review) A DD)-T1 Oa) 0 to 2.000 square feel $80.00 $ 2.001 to 3.600 square feel $128.00 $ PROPERTY OWNER 3.601 to 7.200 square feet $192.00 $ r_. Name: ?H tL. 5 t t✓c 7,201 square feet and greater $255.00 $ Manufactured dwelling or pre-fah(circle one) Address: Connections to building sewer and $80.00] S City: _ J State: ZIP: water supple : -- Commercial, industrial, and dwellings other than one-or Phone: - - -- Fax: - - two-family E-mail: Minimum lee $80.00 i S This installation is being made on residential or farm property Each li.awc �) $21.00 5�J'{ owned by ale or a member of my imnmdiale family, and is . Miscellaneous fees —v�� exempt from licensing requirements under OAR 918-695-0020. 1W storm.sewer, water line $83.50 S Signature: Each fixture, appurtenance,and piping $21.00 S CONTRACTOR INSTALLATION Storm water retention/detention facility $21.00 $ Business name: tG I) Irrigation systems $21.00 S Piping or private storm drainage 521.00 $ Address: systems exceeding the first 100 feet City: State: ZIP: Specialty fixtures $21.00 $ Reinspection Ina.of hrs. x fee per hr.) $80.00 S Phone: - - Fax: - - Special requested inspections(no.of $80.00 $ t:-mail: hrs.x Ice per__ Each additional inspection: (I) $80.00 $ CCI3 license no.: BCD license no.: Plumbing license no.: Medical gas piping Minimum lee $ Print name: Enter value of installation and equipment$ . Enter fee based on installation and equipment value. $ Signature: APPLICANT USE . (A) Enter subtotal of above fees $ (Minimum Permit Fee$80.00) 2, . (13) Investigative fee(equal to[Al) $ (C) Enter 12%surcharge(.12 x [A+B]1 $1__ (D)Technology Fee(5%of[Al) S // 5r TOTAL fees and surcharges(A through D): $ 270 Z_ 440-2500-3(1/1/2013/C0ND SPRINGFIELD CITY OF SPRINGFIELD 225 Fifth St («; . TRANSACTION RECEIPT Springfield,OR97477 OREGON 591-726-3753 811-SPR2014-00612 www.springfield-or.gav 3333 HAYDEN BRIDGE RD permitcenter©springfield-or.gov RECEIPT NO: 2014000624 RECORD NO: 811-SPR2014.00612 DATE:03/24/2014 [DESCRIPTION •ACCOUNT C.ODE/TRANS_CODE`r,' - AmoukT but.. 1 Single-duct exhaust(bathrooms, toilet compartments, utility room: 224-00000-425604 1006 30.00 State of Oregon Surcharge(12%of applicable fees) 821-00000-215004 1099 3.60 Technology fee(5%of permit total) 100-00000-425605 2099 1.50 TOTAL DUE: 35.10 L;PAYMENT9YPE ' PAYOR CASHIER:CCARPENTER°'- - 'COMMENTS_;'" , "AMOUNT.PAID t' '.. Credit Card MATTHEW R CLEARWATERS _ 35.10 07012z TOTAL PAID: - 35.10 • • SPRINGFIELD CITY OF SPRINGFIELD • >4, 225 Fifth St ` at TRANSACTION RECEIPT Springfield,OR 97477 OREGON 541-726-3759 811-S P R2014-00612 www.springfeld-or.gov 3333 HAYDEN BRIDGE RD permitcenter(ryspringfield-or.gov RECEIPT NO: 2014000622 RECORD NO: 811-SPR2014-00612 DATE:03/24/2014 [DESCRIPTION ' '_:7_ ACCOUNT.CODE/TRANS CODE AMOUNT DUE_J Air Handling Unit up to 10,000 cfm 224-00000-425604 1006 18.50 First Appliance Fee 224-00000-425604 1006 80.00 State of Oregon Surcharge.(12%of applicable fees) t 821-00000-215004 1099 11.82 Technology fee (5%of permit total) 100-00000-425605 2099 4.93 TOTAL DUE: 115.25 LPAYMENT TYPE-- ' PAYOR CASHIER:ccARPENTER .___COMMENTS_ d, ,;,_ AMOUNT PAID r, `. i Credit Card MATTHEW R CLEARWATERS 115.25 05366z TOTAL PAID: 115.25 • •