HomeMy WebLinkAboutPermit Plumbing 2018-11-29s p1u111bing Per111it Application
225 fifih s- • spri,Sfiold. OR 97477 • PH(S4 l )726-3753 • f A]((54 ll72'-36'9
Thi, permit;, Issued under OAR 918-780-0060· Permits are issued
expire if work is not started within 180 days of issuance or if work
Sanitation approval verified? D Yes O No
,CATEGORY.-OF CONS~RUCTION
0 Residential I O Government 16.Kl. Commercial
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Address:
City: State: ZIP:
Phone: Fax:
E-mail:
This installation is being made on residential or farm property
owned by me or a member ofmy immediate family, and is
exempt from licensing requirements under OAR 918-695-0020.
Signature:
Address:
City: State: ZIP:
Phone: Fax:
E-mail:
CCB license no.: BCD license no.:
Plumbing license no.:
Print name:
Signature:
• u •••• - ded for 180 oays. ······. , , ,~. issuspen ,+.,e·'··< ,, ..
~ ··· :fff:SCHEDUL1:'.·?'.~:t·/ . ~
,· ,, ¼; \0~<Jost . 1'otal '
,;-- Jt;J!:'.; 0t,,1;·x.,, .. , ··eost Desc ~ption . ,. '"st,.,ea. . n - . 'i'"'
New residential
1 bathroom/I kitchen (includes: first
100 feet of water/sewer lines, hose. $323.00 $
bibs, ice maker, underfloor low-point
drains and rain-drain packages)
2 bathrooms/I kitchen $506.00 $
3 bathrooms/I kitchen $595.00 $
Each additional bathroom (over 3) $128.00 $
Each additional kitchen ( over I) $128.00 s
Residential fire sprinklers (includes plan review)
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 $236.00 $
7 ,20 I square feet and greater $315.00 $
M anufactured dwelling or pre-fab (circle one)
Connections to building sewer and
$99.00 $ water supply
Commercial, industrial, and dwellings other than one- or
two-family
Minimum fee $99.00 $
Each fixture $24.00 $
Miscellaneous fees
100' storm, sewer, water line I . $103.00 $ lo'?.
Each fixture, appurtenance, and piping 1 $24.00 srl"-4
Storm water retention/detention facility $103.00 $
Irrigation systems/Backflow $24.00 $
Piping or private storm drainage $24.00 $ systems exceeding the first 100 feet
Specialty fixtures $24.00 $
Reinspection (no. of hrs. x fee per hr.) $99.00 $
Special requested inspections (no. of
$99.00 $ hrs. x fee per hr.)
Each additional inspection: (1) $99.00 $
;:M~~liii>~''';~'t:~i(!," < ,•J;!,'1~ t }~1 Minimum fee $
Enter value of installation and equipment $ __ .
Enter fee based on installation and equipment value. $ .,, -- llii .• < '¼'-
- C
(A) Enter subtotal of above fees
$ (Minimum Permit Fee $99.00)
(B) Investigative fee (equal to [A]) $
(C) Enter 12% surcharge (.12 x [A+B]) $
(D) Technology Fee (5% of[A]) $
TOT AL fees and surcharges (A through D): $
Last edited 7/1/2018 bjones
A B C D
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