HomeMy WebLinkAboutPermit Plumbing 2019-09-11Plumbing Permit Application
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225 Fifth Streei . Springfi€ld, OR 97477 . PH(541)726-1753 . FAX{541)726"1689
This permit is issued under OAR 918-7E0-0060. Permits are issued only to the person or contractor doing the work. Permits
expire if work is not strrted within 180 days of issuance or if work is suspended for lE0 days.
DEPARTMENT USE ONLY
permir no.: lq'. D I 5)2 " D)
Date: 0r rlt \s
LOCAL GOVERNMENT APPROVAL
Zoning approval verifi ed?! ve'ENo Description ary Cost Total
costea.
Sanitation approval verifi ed?! Yes !No New residential
CATEGORY OF CONSTRUCTION I bathroonL/l kitchcn (includes: rtrst
l00feet ofwater/saner lines, hose
bibs, ice maker, under|loor low-point
{lrains and rain-drain packages)
Residential E Commercial
JOB SITE INFORMATION AND LOC
$333.00 $
Job site address 2 2 bathrooms/l kitchen
cityS 3 bathroon'N/ I kitchencStateztPEach additional bathroom (over 3)
Reference Taxlot Each additional kitchen (over l)
s52t.00 s
$613.00 $
$r32.00 s
$r32.00 S
DESCRIPTION OF WORK Residential fire s nklers includes
0 to 2,000 square feet $102.00 s
2,001 to 3,600 square feet r63.00 $
PROPERW OWNER 3.601 to 7,200 square feet s
cp bto 7,201 square feet and $€ater 24.t0
Manufactured dwelling or pre.frb circlc one3Connections to building sewer and
water supply r02.00 S
City:I State: I Commerciel, industrial, and dwellings other (han one- or
3 Fax tli o-Ie
E-mail Minimum fee 102.00 5
Each fixture s.00 S
This installation is being made on residential or farm property
owned by me or a mernber of my immediate family, and is
exempt from licensing requirements under OAR 918-695-0020
Signatule:
Miscellaneous fe€s
l00 stom, sewer, water line r06.00 s
Each fixtur€, appurtenance. and piping 25.00 S
CONTRACTOR INSTALLATION Storm water retention/detention facility $
Business name gation systems/Backfl ow
ing or private storm
Address I o ve the first 1 feet
ate O I ztP '1fo Specialty fixturesCity,1,/C s
Reinspection (no. ofhrs. x fee per hr.)
vhonefl[Fax Special requested inspections (no. of
hrs. x fee per hr.)€<Or
CCB license no BCD lic se no Each .dditional inspection: (l)
i2s.00 s
t25.00 S
$25.00
$t02.00 $
$102.00 $
sr 02.00 S
Plumbing license no edicel Minimunr fee s
Enter value ofinstallation and equipment $
-Enl€r fee based on installalion and cquipment value $
Signaturc DEPARTMENT USE
(A) Enter subtotal ofabove Ges
(Minimum Permit Fee $102.00)
s
(B) lnvesrigative fee (equalto [A])s
(C) Enter 12olo surcharge (.12 x [A+B])$
(D) Technology Fee (5% of [A])$
TOTAL fees and surcharges (A through D):s
l-asl edired 7i 1/2019 bjones
Crrv on SpnrNcnrnlD, OREGoN
FEE SCHEDULE
E Covemment x
ZIP:
s
Name:
Address:
i106.00
$
E-mail:
P nt name:
Phonejr{