HomeMy WebLinkAboutPermit Plumbing 2011-2-24
Plumbing Permit Application
225 Fifth Street. Springfield, OR 97477. PH(541)726-3753 . FAX(54!)726-3689
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Permit no.:
This permit is issued under OAR 918-780-0060, 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,
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Zoning 'approval verified? DYes D No
Sanitation approval verified? DYes D No
CATEGORY:'OF CONSTRUCTION'.
esidential D Government D Commercial
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Job site address: E. S t-
City:
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'Name:
ZIP: '1 '7 'f 0')
City:
Phone:
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 !Tom licensing requirements under OAR 918-695-0020,
Signature:
.' CONTRACrOR ,INSTALLATION., '
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Plumbing license no.:
Print name:
Signature:
440-2500.J (l1/08/COM)
New residential
I bathroom! I kitchen (includes: first
100 feet of water/sewer lines, hose
bibs, ice maker, under floor low-point
drains and rain-drain packages)
2 bathrooms/I kitchen $374,00
3 bathrooms!l kitchen $439.00
Each additional bathroom (over 3) $95.00
Each additional kitchen (over I) $95.00
Residential fire s rinklers (includes plan review)
o to 2,000 square feet $58,00
2,00] to 3,600 squarefeet $116,00
3.60\ to 7,200 square feet $174,00
7.201 square feet and greater $232,00
Manufactured dwelling or pre-fab (circle one)
Connections to building sewer and
water supply
Commercial, industrial, arid dwellings other than one- or
two-family
Minimum fee
$238,00
$
$
$
$
$
$
$
$
$
$
$
$
Each fixture
Miscellaneous fees
100' storm, sewer, water line
Each fixt.ure, appurtenance, and piping
Storm water retention/detention facility
Irrigation systems
Piping or private storm drainage
s stems exceed in the first] 00 feet
Specialty fixtures
Reinspection (no. ofhrs. x fee per hr.)
Special requested inspections (no. of
hrs. x fee per hr.)
Each additional inspection: (1)
$58.00
$19.00
$76.00 . $
$19.00 $
$19.00 $
$19.00 $
$19.00 $
$19,00 $
$58.00 $
$58,00 $
$58,00 $
Mi.nimum fee $
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Enter value of installation and equipment $
Enter fee based on installation and equipment value.
(A) Enter subtotal of above fees
(Minimum Permit Fee $58.00)
(B) Investigative fee (equal to [A])
(C) Enter 12% surcharge (.12 x [A+B])
(0) Technology Fee (5% of[A])
TOTAL fees and surcharges (A through D):
$
$
$
$
$
TRANSACTION RECEIPT
CIlY OF SPRINGFIELD
225 Fifth St
Springfield, OR 97477
541-726-3753
www.ci.springfield.or.us
811-SPR2011-00300
1622 E ST
permitcenter@ci.springfield.or.us
RECEIPT NO: 2011000351
RECORD NO: 811-SPR2011-o0JOO
DATE: 02/2512011
State of Oregon Surcharge (12% of applicable feesr
Technology fee (5% of penn it total)
Water Line
821-00000-215004
100-00000-425605
224-00000-425603
TOTAL DUE:
9.12
3.80
76.00
88.92
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Credit Card HYDRO PRO INC 88.92
31480
TOTAL PAID:
88.92