HomeMy WebLinkAboutPermit Plumbing 2019-06-19Plumbing Permit Application
225 Fifth Street I Springfield, OR 97477 . PH(541)726-3753 o FAX(541)726-3689
This permit 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 180 days.
SPNIXGFIELD
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LOCAL GOVERNMENT APPROVAL
Zoningapproval verified? E Yes f] No
Sanitation approval verified? [ Yes f] No
CATEGORY OF CONSTRUCTION
)fi[Residential E Government E Commercial
JOB SITE INFORMATION AND LOCATION
Jobsite address: *ltl+ _f7fr S+,
City {^.rt State'. Q!zw:97t/T
n"r"r"n.Li Taxlot.
DESCRIPTION OF WORK
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PROPERTY OWNER
Name:
Address:t7
City: J,a/7)State: pp zrc: Q7t/lSt)
Phone:- 54/ -r)t-sr)f2 Fax:
E-mail
This made on or farm property
family, and isowned
exempt
of my
1 8-695-0020.
L--E o N f nac rO R-I N STAL LAT I O N
Business name: $1 1a / fno,S.l*-f
Address: SbZn q SAn-[i^^., l-h^lu
City: I e|y1,ay\11n State: D lZ zrc:$3g5
Phone:${l -451'SQa Fax:
E-mail
CCB license no.: [$]t /.i,BCD license no.
Plumbing license no.
Print name
Signature:
FEE SCHEDULE
Description Qty.Cost
ea.
Total
cost
New residential
I bathroom/l kitchen (includes : first
l00feet ofwater/sewer lines, hose
bibs, ice maker, undedloor low-point
drains and raindrain packages)
$323.00 $
2 bathrooms/l kitchen $506.00 $
3 bathrooms/l kitchen $59s.00 $
Each additional bathroom (over 3)$128.00 $
Each additional kitchen (over I )$128.00 $
Residential fire sprinklers (includes plan review)
0 to 2,000 square feet $99.00 $
2,001 to 3,600 square feet $158.00 $
3,601 to 7,200 square feet $236.00 $
7,201 square feet and greater $315.00 $
Manufactured dwelling or pre-fab (circle one)
Connections to building sewer and
water supply $99.00 $
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 s103.00 s
Each fixture, appurtenance, and piping 3 $24.00 $
Storm water retention/detention facility $103.00 s
lrrigation systems/Backfl ow $24.00 $
Piping or private storm drainage
first 100 feetsvstems exceedins the
g2'1.00 $
Specialty fixtures $24.00 $
Reinspection (no. ofhrs. x fee per hr.)$99.00 $
Special requested inspections (no. of
hrs. x fee per hr.)s99.00 $
Each additional inspection: ( I )$99.00 $
Medical qas piping Minimum t'ee S
Enter value of installation and equipment $
-.Enter fee based on installation and equipment value.$
DEPARTMENT USE
(A) Enter subtotal ofabove fees
(Minimum Permit Fee $99.00)
$
(B) Investigative fee (equal to [A])$
(C) Enter 12olo surcharge (. l2 x [A+B])$
(D) Technology Fee (5% of [A])$
TOTAL fees and surcharges (A through D)$
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SCCIS onsNucfu{"6u- tt- o bo?fo{I(
DEPARTMENT USE ONLY
permitno.: n-(ffil=o"(
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l-ast edited 7 I I l20l 8 bjones
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