HomeMy WebLinkAboutPermit Plumbing 2019-09-27Cmv or SprNGFIELn, Onncox
a Plumbing Permit Apptication DEPARTMENT USE ONLY
Permit no.: t I - at ZACf-fut
Date: q /zr/z"rq
SPFI NGFIELS
h,
225 Fifth Street o 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.
FEE SCHEDULE
Description ary Cost
ea.
Total
cost
New residential
1 bathroom/l kitchen (includes : first
100 feet ofwater/sewer lines, hose
bibs, ice maker, underfloor low-point
drains and rain-drain packnges)
$333.00 $
2 bathrooms/l kitchen $s21.00 $
3 bathrooms/l kitchen $613.00 $
Each additional bathroom (over 3)$132.00 $
Each additional kitchen (over 1 )$r32.00 $
Residential fire sprinklers (includes plan review)
0 to 2,000 square feet $102.00 $
2,001 to 3,600 square feet $163.00 $
3,601 to 7,200 square feet $243.00 $
7,201 square feet and greater $324.00 $
Manufactured dwelling or pre-fab (circle one)
Connections to building sewer and
water supply s102.00 $
Commercial, industrial, and dwellings other than one- or
two-family
Minimum fee $102.00 $
Each fixture $25.00 $
Miscellaneous fees
100' storm, seweq water line $r06.00 $
Each fixture, appurtenance, and piping $25.00 $
Storm water retention/detention facility $r06.00 $
I rrigation systems/Backfl ow $2s.00 $
Piping or private storm drainage
systems exceeding the first 100 feet 825.00 $
Specialty fixtures $25.00 $
Reinspection (no. ofhrs. x fee per hr.)il02.00 $
$102.00 $
Each additional inspection: (l)$r02.00 $
Medical Minimum fee $
Enter value of installation and equipment $
Enter fee based on installation and equipment value.s
DEPARTMENT
(A) Enter subtotal ofabove fees
(Minimum Permit Fee $l 02.00)$
(B) Investigative fee (equal to [AJ)
(c)Enter 12%surcharge (12 x lA+Bl)$
$
$
LOCAL GOVERNMENT APPROVAL
Zoningapproval verified? E Yes E No
Sanitation approval verified? f] Yes E No
CATEGORY OF CONSTRUCTION
E Residential E Govemment I Commercial
JOB SITE INFORMATION AND LOCATION
Job site address: 2lCq :5 1,{-
State: fi f(ztP:?7q77
Reference:Taxlot.
DESCRIPTION OF WORK
.A,S/r-n f dt-t L.a1qe (yt n ci,t)
tl
PROPERTY OWNER
zr'tName:
Address:
City: 9Vr14r4. 1/State:/fi(ztv:/lt2 7
L/
Phone Fax:
E-mail
This installation is being made on residential or farm property
owned by me or a member of my immediate family, and is
exempt from licensing requirements under OAR 918-695-0020
Signature:
CONTRACTOR INSTALLATION
o
/'a
Business name
Address
City:*t-l+ghzZ State:fl(zIP:l7 ?77
oPhoneJT/t4-
sU dLt
BCD license no.CCB license no.
E-mail kl4 t'
t-Print name:/ r?,t
Signature
Lasr edired 7/l/2019 bjones
Specral requested inspections (no. of
hrs. x fee per hr.)
USF
$
J
Fax:
Plumbing license no.: