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HomeMy WebLinkAboutPermit Plumbing 2020-02-04225 Fifth Street . Springfield,,OR97477 . PH(541')726-3753 i FAX(541)726-3689 Plumbing Pernrit Application ^-'- Oe.^,.ttL 5I"A DEPARTMEI{T USE O${LY Permit no': 3- 11 - 0 021 )-b Date ;. l,al>o SPEINGT'ELO &, "- -(U/^' This permit is issued under OAR 918-780-0060. Permits are issued only to the person or contractor doing the work. Permits expire ifwork is not started within 180 days ofissuance or ifwork is suspended for 180 days. LOCAL GOVERNMENT APPROVAL Zoningapproval verified? [ Yes n No Sanitation approval verified? E Ye. E No CATEGORY OF CONSTRUCTION [,Residential ! Govemment E] Commercial JOB SITE INFORMATION AND LOCATION Job site address: Xhf) (\ State zrPQ*]t{-]l Referenc): \Taxlot. DESCRIPTION OF WORK d, @rrf gffi PROPERTY OWNER Name: Address: City:State:ZIP: Phone Fax: E-mail: This installation is being made on residential or farm property owned by me or a rnember of my immediate family, and is exempt from licensing requirements under OAR 9l 8-695-0020 Sigrrature: CONTRACTOR INSTALLATION Business name:t Address r77 City: f6Qt't7d State: @ ztP: ? 74al t-lFax E-mail:,L Lrz 4 2CCB license no.BCD license no.q P license no. Print name Signature: tffi-$,*H ffi i vr- 'Y<.^) V\^4^ +t{ ' \ra.JA^tto''---' 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): t" lasr edrred 7/lr2ol9 b-iones f-' ' - .+ str's LqU,qV _1 5 fr ,7