HomeMy WebLinkAboutPermit Plumbing 2019-08-06Plumbing Permit Application
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225 Fifth Street . Springfield. OR 97477 . PH(541)726-3153 . FAX(54 | )726-3689
This p€rmit 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 days of issuance or if work is suspended for 1t0 days.
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Crrv oF SPRTNGFTELD, OnncoN
DEPARTMENT USE ONLY
pe,mit no.:lj- 0O p,oq- PLtu\
0Date: Q,lt \rq
LOCAL GOVERNMENT APPROVAL FEE SCHEDULE
Total
cost
Coslaryea.Zoning approval verifi ed?
Sanitation approval verified?
E Yes
! Yes
Euo
nNo
Description
\eI\ residential
1 bathroorni I kitchen (includes: Jirst
100 feet ofwater/sever lines. hose
bibs, ice moker, undefloor low-point
drains and rain-drain packages)
CATEGORY OF CONSTRUCTION
JOB SITE INFORMATION ANO LOCATION
dential $33-1.00 $
s521.00 $
S
taxlot.: l? O Lq,
2 bathrooms/l kitchen
Each additional kitchen (over l)
3 bathrooms/l kitchen
Each additional bathroom (over 3)
i+6.
ztPQ47?
Job site address: !
City:s6l-1.00 $
$r32.00 $
$ l -12.00 $
DESCRIPTION OF WORK R€sidential fire includes lan review
s102.00 $0 to 2,000 square feet
PROPERTY OWNER
CONTRACTOR INSTALLATION
$
ZIP
$
$
$
5
s
5
-\
$
\Ianufactured d$elli or re.fob (circle one)
Signature
a lL<
l6-1.002,001 to 3,600 square feet
.t3.003,601 to 7,200 square feet
2.1.007,201 square fect and greater
102.00
Commercial, industrial, and dwellings other than one- or
trr o-famil
Minimum fee
5.00Each fixture
Miscelloneous fees
106.00100 storm, sewer, water line
00Each fixrure, appunenance, and piping
Stom water retention/deteotion l'acilify
City State
E-mail
This installation eing made on residential or farm property
Iber of
o
Connections to building sewer and
water supply
Name:6{
address:.n6
owned by me
exempt from I
family, and is
AR 918-695-0020
$25.00 $
i25.00 $
t25.00 $
$102.00 $
s 102.00 $
BCD license no
Z.IP
orTnslprivate8Pipin
s exceedi the first 100 feet
hrs x fee hr.)
Erch additional inspection: (l )CCB license no
Address:
City
Fax:
lrrigation systems/Backfl ow
Specialty fixtures
Reinspection (no. ofhn. x fee per hr.)
Special requested inspertions (no. ofPhone
$5102.00
$
5
DEPARTMENT USE
Enter fee based on installation and equipment value
Enter value ofinstallation and equipment $
-
Medical M ininrum feePlumbing license no
Signature
Print name
'lo(,
(A) Enter subtotal ofabove fees
(Minimum Permlt Fee $102.00)
S(B) Investigative fee (equal to [A])
5(C) Enter l27o surcharge (.12 x [A+B])
$E-70(D) Technology Fee (5% oflAl)
s lL4.oTOTAL fees and surcharges (A through D):
l-asl €dited 7/12019 bjones
6
! Governrnent E Commercial
ryReference:
Fax:
8102.00
i106.00
Business name:
State:
E-mail: