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
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Reference Taxlot.
DESCRIPTION OF WORK
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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:
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This installation is
owned by me
exempt from
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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+
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ccB license ro.iltl53'7 )-BCD license no.
Plumbing license no.
Print name:
Sisnature:
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SFRINGFIELO
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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.
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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):$
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DEPARTMENT USE ONL Y
Permit N mno.?(I
Date:3o 2o
Last edited 7/1/2019 bjones
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