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HomeMy WebLinkAboutPermit Plumbing 2020-01-30Crry or SpnrnrcFIELD, ORrcoN Plumbin g Permit Application 225 Fifth Street a Springfield,oR97477 )pu6qt)tzaj 753 t FAX(541 )726-3659 LOCAL GOVERNMENT APPROVAL Zoning approval verified? E yes ENo Sanitation approval verified? E yes E No CATEGORY OF CONSTRUCTION E Residential I Govemment ffiCommercial JOB SITE INFORMATION AND LOCATION Job site address: 3 \tB GaJ.erJer.,r L-oop c )State:tK zr:\7r|11 Reference Taxlot. DESCRIPTION OF WORK \ zor ' +" 3e\r)<3c 3o(- A'Aowy5l-,,.r-r*ql,ur. I i s PROPERTY OWNER Name:o Chrr.. Address: -)-<.h *d. br City: fU[qRr,4,R-State:O K zrP:t ?+o 8 Phone:9fr 55+ G agB Fax: E-mail c Lo This installation is owned by me exempt from ora of my Signature: CONTRACTOR IN'ALLATION Business name: ET flA i\\t,r- Cong a.c Address: Po goX -76O city: (\qCCp\a-State: Q (ztP:ll q5+ ptoneS{\-133 - 31+5 eu,,S*[ 9]3 3q+s' E-mail u t/Y1 r a l^--) ccB license ro.iltl53'7 )-BCD license no. Plumbing license no. Print name: Sisnature: :.^.^E; SFRINGFIELO & This permit is issued under oAR 918-780-0060. Permits are-issued only to the person or conrractor doing the work. permirsexpire ifwork is not started within I80 days ofissuance or irwort is suspenoea for lg0 days. n^ox t' UF-l DL{/-.}--L \r'.-"^^-"-),ru*- u-- FEE SCHEDULE Description Qty Cost ea. Total cost New residential I bathroom/l kitchen (includes : first 100 feet of water/sewer lines, hose bibs, ice maker, undetfloor low-point drains and rain-drain packoges) $333.00 s 2 bathrooms/l kitchen $s21.00 $ 3 bathrooms/1 kitchen $613.00 $ Each additional bathroom (over 3)$132.00 $ Each additional kitchen (over 1)s132.00 $ 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 1102.00 $ Each fixture $25.00 $ Miscellaneous fees 100' storm, sewer, water line 'L t106.00 $ lotl Each fixture, appurtenance, and piping $2s.00 s Storm water retention/detention facility $106.00 $ Irrigation systems/Backfl ow $2s.00 SQA Piping or private storm drainage systems exceeding the first I00 feet t $25.00 su< Specialty fixtures t25.00 $ Reinspection (no. ofhrs. x fee per hr.)1102.00 $ Special requested inspections (no. of hrs. x fee per hr.)!102.00 $ Each additional inspection: (l)$102.00 $ Medical gas piping Minirnurr 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) $ ZtaL (B) Investigative fee (equal to [e])$ (C) Enter l2o% surcharge (.12 x [A+B])$ (D) Technology Fee (s% of [A])g I r'11/ TOTAL fees and surcharges (A through D):$ A.F- \* Dq,^.',-^-\.-'{--^-f,"^ l-;"EW lq- DEPARTMENT USE ONL Y Permit N mno.?(I Date:3o 2o Last edited 7/1/2019 bjones \.*y'3 PlSo4 ..{\ )-9q