HomeMy WebLinkAboutPermit Plumbing 1981-6-15
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Idne; county"
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CH ECKLIST ~(.
PLUMBING/ MECHANICAL
OFFICIAL USE ONLY
Appli./ \2.oq-'8\
Pen11l t # ".,)
APPLICANf INFORMATION:
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~ame or~irm-Please Prlnt) .
PLUMBING CONTRACTOR
o Yes Firm
~o:}j ~) T:2fo-oQ2b
'\,Mallmg AddreSS) (t'lty or Town) (Zlp Code)
rn- b83- 3bZZ
Cont. OSRT'
Address
o No o Self
~1ECHANICAL CONTRACTOR 0 Yes Firm Cont. OSR#
\
Address ,
~ N~1f DIRECTIONS TO SITE CflDP'J\., ed ' ~ ~ 0Yl
(~(hQO-fu6. _Co. _ ~f}2~NJ J.) / ~ l) .-/:rtJm.
Type of Fixture Number of Each Fee On Each Total
Sink
Lavato!" [Wash Basin]
Tub (with or without shower)
Shower. separate
Water Closet [toilet/urinal]
Dishwasher
Disposer (garbage grinder)
Washing Machine
Water Heater
Floor Drain
Sewer--lst 50ft.
each additional 100 ft.
Water Service--lst 100 ft.
each adclitional 100 ft.
Storm and Rain Drain--lst 100 ft.
each additional 100 ft.
Special Waste Connection
Sewage and Sump Pump [eiector]
~bbiie Horne Sewer and Water
Other (specify)
SUB-TOTAL (Minimum $10.00)
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$ 5.00
5.00
5.00
5.00
5.00
5.00
5.00
5.00
5.00
5.00
15.00
10.00
15.00
10.00
15.00
10.00
5.00
5.00
10.00
I TOTAL FEE
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IO.CO
.-10
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Type of Equipment
MECHANICAL
Nwnber of Each
Fee on Each
Total
Mechanical Permit Base Fee
Furnace UP to 100,000 BTU/H
Furnace over 100.000 BTU/H
Clothes Dryer Vent
Bathroom Ventilation Fan & Duct
Range Hood with Mechanical Exhaust
Wood Stove
Air Conditioner Only
Heat Ptmm
Floor Furnace
Gas Piping System 1 to 4 Outlets
Per Outlet
$ 10.00
$ 6.00
7.50
3.00
3.00
4.50
6.00
6.ob
6.00
6.00
.50
Other (specify)
. SUB-TOTAL I
1 certlty tnat all Plu..," '''~ WOrK WIll U~ UUII~ '" I
accordance with applicabl& provisions of Oregon TOTAL FEE
Revised Statutes Chps. 447 & 693 and applicable
codes. and tha t no help wi 11 be employed unless Permi t
l~censed unPerj>RS 693._ ~ J_ ~ issued bv
Slgnature " r;;j,.b:1Jz ~ l t. (LkJ -' _. J Date
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f LANE COUNTY
"APPLICANT AKIN~ LORRAINE
,~u~ 1802050~00201 SUBDIV
~EW BLDG TY~E USE R NO BDRMS
4tCODE APPL NO , ACTION DESCRIPTION
BP
BP
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BP
BP
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PL LC 1~0981 PL PLUMBING
EL NO. FIXTURES: 4 NO.
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EST. COMPL~TION DATE 061581
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DEPT ENV MGT RECEIPT ~ 130981 DATE 061581
ADDR 4982 JASPER RD., SPFD., OREGON ..
LOT BLK
00 NO UNITS 001 NO STORIES NO BLDGS 001
SQ FT UNIT COST VALUATION FEE' DAYS"
..
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ONLY
CONNECTORS:
MECHANICAL FEE
STATE SURCHARGE
PLAN CHECK FEE
..
15.00 EACH =
47- .
507-
20.00
..
0.80
10.00
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SDS
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1 "
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SI
PCK
OTH
IS'S
o
TOTAL FEE**
30.80 CK
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