HomeMy WebLinkAboutPermit Plumbing 2020-02-04225 Fifth Street . Springfield,,OR97477 . PH(541')726-3753 i FAX(541)726-3689
Plumbing Pernrit Application
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DEPARTMEI{T USE O${LY
Permit no': 3- 11 - 0 021 )-b
Date ;. l,al>o
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This permit is issued under OAR 918-780-0060. Permits are issued only to the person or contractor doing the work. Permits
expire ifwork is not started within 180 days ofissuance or ifwork is suspended for 180 days.
LOCAL GOVERNMENT APPROVAL
Zoningapproval verified? [ Yes n No
Sanitation approval verified? E Ye. E No
CATEGORY OF CONSTRUCTION
[,Residential ! Govemment E] Commercial
JOB SITE INFORMATION AND LOCATION
Job site address: Xhf) (\
State zrPQ*]t{-]l
Referenc): \Taxlot.
DESCRIPTION OF WORK
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PROPERTY OWNER
Name:
Address:
City:State:ZIP:
Phone Fax:
E-mail:
This installation is being made on residential or farm property
owned by me or a rnember of my immediate family, and is
exempt from licensing requirements under OAR 9l 8-695-0020
Sigrrature:
CONTRACTOR INSTALLATION
Business name:t
Address r77
City: f6Qt't7d State: @ ztP: ? 74al
t-lFax
E-mail:,L Lrz 4
2CCB license no.BCD license no.q
P license no.
Print name
Signature:
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Cmv oF SPRTNcFIELD, OREGoN
FEE SGHEDULE
Description Qty Cost
ea.
Total
cost
New residential
x $333.00 $
I bathroom/l kilchen (includes: first
100 feet ofwater/saner lines, hose 4
bibs, ice maker, underfloor low-poinl <
drains and rain-drain packoges)
$s21.00 $2 bathrooms/l kitchen
$6t3.00 $3 bathrooms/l kitchen
$132.00 $Each additional bathroom (over 3)
Each additional kitchen (over I )$r32.00 $
Residential lire sprinklers (includes plan review)
0 to 2,000 square feet sr02.00 $
s163.00 $2,001 to 3,600 square feet
3,601 to 7,200 square feet t243.00 $
7,201 square feet and greater t324.00 s
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-familv
i102.00 $Minimum fee
Each fixture $25.00 $
Miscellaneous fees
100' storm, sewer, water line fl 06.00 $
I t25.00 s7iEach fixture, appurtenance, and piping
Storm water retention/detention facilitv t106.00 $
$Irrigation systems/Backfl ow t25.00
Piping or private storm drainage
svstems exceedins the first 100 feet x2s.00 s
Specialty fixtures 025.00 $
Reinspection (no. ofhrs. x fee per hr.)$I02.00 $
Special requested inspections (no. of
hrs. x fee per hr.)$102.00 $
Each additional inspection: (i)$102.00 $
$Medical gas piping Minirnurn fee
Enter value of installation and equipment $
-.Enter fee based on installation and equipment value.$
DEPARTMENT USE
(A) Enter subtotal ofabove fees
(Minimum Permit Fee $102.00)
AC$7>t
((B) Investigative fee (equal to [A])
(C) Enter l2oZ surcharge (.12 x [A+B])$
$(D) Technology Fee (5% of [A])
sTOTAL fees and surcharges (A through D):
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