HomeMy WebLinkAboutPermit Plumbing 2019-12-20Crrv or SpnrNGFIELn, 0RnGoN
Plumbing Permit Application DEPARTMENT USE ONLY
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SPEINGFIELD
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225 Fifth Street o Springfield, OR 97477 . PH(541)726-3753 . 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 Qty Cost
ea.
Total
cost
New residential
1 bathroom/l kitchen (includes: first
100feet ofwater/sewer lines, hose
bibs, ice maker, underfloor low-poin,
drains and rain-drain packages)
$333.00 $
2 bathrooms/l kitchen ts2l.00 $
3 bathrooms/l kitchen $613.00 $
Each additional bathroom (over 3)$132.00 $
Each additional kitchen (over 1 )$132.00 $
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 $102.00 $
Commercial, industrial, and dwellings other than one- or
two-family
Minimum fee $102.00 $
Each fixture 4 $2s.00 $
100' storm, sewer. water line $t06.00 $
Each fixture, appurtenance, and piping $25.00 s
Stomt water retentior/detention facility u06.00 $
Irrigation systems/Backfl ow t25.00 $
OT storm $25.00 $
Specialty fixtures t25.00 $
Reinspection (no. ofhrs. x fee per hr.)$102.00 $
hrs. x fee hr.)H02.00 $
Each additionat inspection: (l)$102.00 $
Medical Minimum fee $
Enter value ofinstallation and $
Enter fee based on installation and $
DEPARTMENT USE
(A) Enter subtotal ofabove fees
(Minimum Permit Fee $r02.00)$
(B) Investigative fee (,equal to [A])$(c)Enter 12%surcharge (2 x lA+BJ)
(D)Fee (5%o of iAl)
$
$
$
t S
oK
LOCAL GOVERNMENT APPROVAL
Zoringapproval verified? ! Yes E No
Sanitation approval verified? ! Yes fl No
CATEGORY OF CONSTRUCTION
I Government E CommercialE Residential
JOB SITE INFORMATION AND LOCATION
Job site address: 5250 High Banks Rd Suite #t640
Springfield State:OR ZIP: 97478
Reference Taxlot.
DESCRIPTION OF WORK
PROPERW OWNER
Name:s
Address:
State:ZIP:
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 9i 8-695-0020.
Signature:
CONTRACTOR INSTALLATION
Business n6ms. Kevin Cohen Plumbing
Address: 1084 Postal Way
City: Springfield State: OR ZIP:97477
Phone:541 -OOZ- 9208 Fax:541 345 - 4808
E-mail : t.olmstead@reynoldselectric.com
CCB license no.:176311 BCD Iicense no..PB363
Plumbing license no.' PB363
Print name: Garett Connell
Signature:
Last edited 7 I I /2019 bjones
v*w
-7
Miscellaneous fees
svstems exceedins the
equipment
equipment value.
New construction tenant infill - toilet, lav, water heater, sink
t-
City:
S