HomeMy WebLinkAboutPermit Plumbing 2020-02-14Ctrv or SpnmGFIELD, ORrcou
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Plumbing Permit Application
LOCAL GOVERNMENT APPROVAL
Zoning approval verified? E Yes E lo
Sanitation approval verified? ! Yes D No
CATEGORY OF
E Residential E Government D Commercial
JOB SITE INFORMATION AND LOCATION
Job site address: 1944 I STREET
City: SPRINGFIELD state: oR ZtP: 97477
Reference:Ta,xloL
DESCRIPTION OF WORK
REPLACE SHOWER AND WATER HEATER
PROPERW OWNER
Name: SHIRLEY NAGY
Address: 1944 I STREET
City: .qppllgcFtFt D State: OR ZIP: a7A77
Phone: 5417448918 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 9lE{95{020
Signature:
CONTRACTOR INSTALLATION
Business name: J$/l\l RIVERS PLUMBING
Address: 1S2S IRVING ROAD
City: pl tcFNF State:6p ZtP:97401
Phonc: 6,al Afl,A1AAA Fax: q41 aqgp77?
E-mail: .;r-p161huinrn nom
CCB license no.: 176qq BCD license no.:
Plumbing license no.: 20-S6pB
Printname: -+tcr QMITI-{
SPFtpCFrEtO
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0 97477 .
This permit is issued under OAR 9f 8-780-0060. 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
I bathroom/l kitchet (irc ludes : firsr
IO0Jeet ofvater/sever lines, hose
bibs, ice maker, utderfloor lot,-point
drains and raindain paclages)
$333.00 $
2 bathrooms/l kitchen t521.00 $
3 bathooms/l kitchen s613.00 S
Each additional bathroom (over 3)tr32.00 $
Each additional kitchen (over I )ir32.00 s
Residential fire sprinklers (includes plen review)
0 to 2,000 square feet 9102.00 s
2,001 to 3,600 square feet $163.00 $
3,601 to 7,200 squarc ftet t2.t3.00 $
7,201 square feet and greater s324.00 $
IVlanufactured dwelling or pre-fab (circle one)
Connections to building sewer and
waler supply s102.00 $
Commercial, industrial, and dwellings other than otre.or
two-family
Minimum fee ir02.00 $
Each fi,rture s25.00 $
Miscellaneous fees
100' stonn, sewer, water line il06.00 $
Each fi.xture, appurtenance, and piping )t2s.00 $
Storm water retention/detention facility t106.00 $
Irrigation systems/Backfl ow i25.00 $
Piping or private storm drainage
svstems exceedinp the first 100 feet s25.00 $
Spccialty Exrures i2s.00 $
Reinspection (no. ofhrs. x fee per hr.)s102.00 c
Special requested inspections (no. of
hrs. x fec per hr.)s102.00 $
Erch rdditionrl inspection: (1)sr02.00 s
Medicd gas piping Minimum fee $
Enter value of installation and equipment $
-.Enter fee based on installation and equipment value.$
DEPARTMENT USE
(A) Enter subtotal olabove fees
(illinimum Permit Fce $102.00)
$ toz.oo
(B) Invcstigativc fcc (equal to [A])$
(C) Enter 12% surcharge (.12 x [A+B])$ 1))a
(D) Technology Fee (s% of[A])$ 5io
TOTAL fees and surcharges (A through D):$ { to ?/.
a
DEPARTMENT USE ONLY
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Lasr edited 7/l/2019 bjones
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