HomeMy WebLinkAboutPermit Plumbing 2011-6-2
Plumbing,'Permit Application
225 Fifth Street. S4~rr[77 · b41:726fty ~~)72~b Date:
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.
,1'C:,f,i:iY;:YI;]OCAL; ;G(jVERNMENT''A.PP,ROVA1Y~",~~"li'iW
Zoning approval verified? 0 Yes 0 No
Sanitation approval verified? 0 Yes 0 No
CATEG.oRY OF C.oNSTRUCTI.oN
Residential 0 Government 0 Commercial
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. Name:
ZIP:
City:
Phone: Sit - (;54-
E-mail:
This installation is being made on residential or farm property
owned by me or a member of my immediate family. and.!s
exempt from licensing requirements under OAR 918-695-0020,
Signature:
. C.oNTRACTOR 1
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ZIP:
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E-mail:
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Signature: C':l_,/' ~\ \\I;\()~..r \)
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ATTENTION: .oregon law requires you to '~\'{ '\ I',Cl \)p\
follow rules adopted by the .oregon Utility .
Notification Center. Those rules are set forth
in CAR 952-001-0010 through CAR 952-001-
0090. You may obtain copies of the rules by
calling the center. (Note: the telephone
number for the .oregon Utility Notification
Center is 1-800-332-2344).
Print name:
440-2500-) (1 1I08/COM)
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New residential
1 bathroomll kitchen (includes: first
J 00 feet of water/sewer lines, hose $238.00 $
bibs, ice maker, under floor /ow~point
drains and rain-drain packages)
2 bathroomsll kitchen $374.00 $
3 bathroomsll kitchen $439.00 $
Each additional bathroom (over 3) $95,00 $
Each additional kitchen (over 1) $95.00 $
Residential fire sDrinklers (includes Dlan review)
o to 2,000 square feet $58.00 $
2,001 to 3,600 square feet $116.00 $
3,601 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 $58.00 $
water supply
Commercial, industrial. and dwellings other than one~ or
two-family
Minimum fee $58.00 $
Each fixture $19.00 $
Miscellaneous fees
100' storm, sewer, water line I $76.00 $ 7J[
Each fix~ure, appurtenance, and piping $19.00 $ ,
Storm water retention/detention facility $19.00 $
Irrigation systems $19.00 $
Piping or private storm drainage $19.00 $
svstems exceedinu the first 100 feet
Specialty fixtures $19.00 $
Reinspection (no. of hrs. x fee per hr.) $58.00 $
Special requested inspections (no, of $58.00 $
hrs. x fee per hr.) . _nll
Each ad~~~,\~ ~c ~~~1\l. $58.00 $
';&~~F.!iil1'~!ilfu'i'O.~ Mi,nimum fee $
\~J?rltfl\ \\iiU~~({Np,S:iall ibn and equipment $
~n\~ f~e'based on installation and equipment value, $
~""'-~_lllr\"",,--'"'^'-'.n---ll\ii~~'mil""
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'(A) Enter subtotal of above fees 7~ 6
(Minimum Permit Fee $58.00) .;
(B) Investigative ree (equal to [A]) $ '1/' ~
(C) Enter 12% surcharge (.12 x [A+B]) $ 3~
(D) Technology Fee (5% of [A]) $
TOTAL fees and surcharges (A through D): $ Xl( <
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~OREGON
TRANSACTION RECEIPT
CITY OF SPRINGFIELD
225 Fifth 81
Springfield,OR 97477
541-726~3753
www.cLspringfield.or.us
. 811-SPR2011-01258
4725 71ST ST
pennilcenter@ci.springfield.or.us
RECEIPT NO: 2011001402
lDES.CRI~tION '
State of Oregon Surcharge (12% of applicable fees)
Technology fee (5% of permit total)
Water Line
RECORD NO: 811-SPR2011-01258 DATE: 06/02/2011
.~ .:;<~:' ," -~AC.CO.uN:t:..C.ODE': ,':; ';1~/AMOUNJ_D.lJE"
821-00000-215004 9.12
100-00000-425605 3.80
224-00000-425603 76.00
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TOTAL DUE, 88.92
P,AXOR.:.E_~HJ!'lt.!'~H~9~ L-L.:.:';C:OIVIIVIEN:r:S~":~L_ _~__-"_ ~1!!~~~_____
GARY MUSTIN
, p,AXMEN..T J'iP,E,__
Credit Card
00205b
88.92
TOTAL PAID:
88.92