HomeMy WebLinkAboutPermit Plumbing 2019-02-15~ 0 2 /1 5 /2 0 1 9 0 9 :2 8
Plumbing Perm it Application
15416889272
C IT Y O F S P R IN G F IE L D ., O R F.G O ~
---· -----· -· 225 :Fiflh Stl"ffl • Springfield, OR 97477 • PH(S4l)726-3753 • FAX(541)726-3689 Date: .;J.,
T his permit is issued under OAR 918-780-0060, Permits are issued only to the person or contractor doing the work, Permits
e;q,ife ifworlc; is not started within 180 days oflssuance or ff work 11 suspended for 180 days.
Zoning approval verified'! D Y es D No
Sanitation approval verified? D Yes O No
N am e:
A ddress:
Cit)': I State: I ZIP:
Phone: SZ:!{-4~-0~Z'-lo j Fa,;: Sl-t( U/'-1. Q ~f?
E-mail: f'I\U~€,_ ~Ol.JUR_~u:,(.,---(, (...oY--1
This installation is being m ade on residential or farm property
owned by m e or a m ember of m y im m ediate fam ily, and is
exempt from licensing requirem ents under O AR 918-69S-0020.
Signature:
State: D Q. I ZTP: ~f-4.0
Phone: ~ l-C. l'"~ l '-1~'1
CCB license ne.: r ~{.. '( .S I BCD license no.:
Signature:
TWIN RIVERS PLUMBING PAGE 01/01
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N ew ru id en ti•I
I bathroom/I kitchen (include.,: ft~t
I 00 feel of water/sewer lines, hose $323,00 $ bibs, ice malrer, underfloor low-point
drnins Qlld rain-drain packlZgu)
2 bathrooms/I kitchen $SOM O $
3 bathrooms/I kitchen $595.0D s
Each 11dditional bathroom (over 3) $128.00 $
Bach additional kitchen (over 1) $1Z8,0D s
R esid en tial tin sprin'klcn {includ~ plan revjew)
0 to 2,000 square feet $99.00 $
2.001 to 3,600 square feet $158,00 s
3,601 to 7,200 square feet $238.00 $
7,201 square feet and greater $J15.00 $
M an u ractu red dw ellin g or p re-fab (circle one)
Connections to building sewer and $99,00 $ water supply
C om m ercial, in d u strial, •~d d"felliti,:s other than one- or
two-family
Minimum fee $99.00 $~
Each fixture $24.00 $
M iscellaneous fees
I 00' storm, sewer, water line $103,00 $
Each fixture, appurtenance, and piping $24,00 $
Storm water retention/detention facility S103.00 s
Irrigation systems/Backflow $24.00 $
Piping or private storm drainage $24.00 $ svstc:rns exeeedlne the fir~ 100 feet
Specialty ,fixtures $24.00 $
Reinspecticn (no. of hrs. x fee per hr.) $19.00 $
Special requested inspections (no. of $99,00 $ hrs. x fee per hr.)
Each nddlHonal lnspectio": (I) $99,00 $
Med{tliitgii@ttttirt;~.;;;/'f(?-E,_':-~:: · Minimum fee s
Enter value of installation and equipment$
Enter fee based on installation and equipment value. s
~~
.. - . -
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(A) Enter subtotal of above fees $ 9'4 / (M in im um Perm it Few: $99.00)
(B) Investigative fee (equal to [A]) $
CC) Enter 12¾ 5\2.-ctmrgc (.12 x [A+B)) $ ,, 'is~
(D) Technology F c:c (5% of(A]) $ Lt~
TOTAL fees Rnd surcharges (A through D): $l15 ~
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