HomeMy WebLinkAboutPermit Plumbing 1982-1-7
.,;...
'IRS, TL ,l7.....0;)-C>~
lane county
...~
." . *" lCO '., '
. I. ADDRESS 417 (lw1 0 . . (:trr. Lt::e
CHECKLIST
PLUMBING / MEeHAN leAL
OFF I AL USE ONLY
LC--:#=-
, Appl~. / f:P..- d:JIf)_
Penm t #~ { J~
:'h ..'
APPLI'cANT INFORMATION:
'i\~.M~ (55'1&-~. Will~ I~' ey, :
~ame or"Fl~lease! PnntJA .:,'~' .' eM~,i11g Add,rl~sl. ~ "e,Cft. or TO~ CZIP.~Code)
.' . ,.... uL.One.h~ ('\€,~~ ~ .
PLUMBING CONTRACTOR D Yes ,Finn ,," ' , , . Cont. SR#
Address
DNoDSelf
MEa-IANICAL CONTRACTOR DYes Firin
. Address
Cont. OSR#
0.<:...
, Type' of Fixture
Nwnber of Each
Fee On Each
$ 5.00
5.00
5.00
5.00
5.00
5.00
5.00
5.00
5.00
5.00
l5.ob
10.00
15.00
10.00
15.00
10.00
.5.00
5.00
10.00
Total
Si~'
Lavatory (Wash Basin)'
Tub. (with or without shower)
Shower 1. separate .
Water Closet (toilet/urinal)
Dishwasher .
Disposer ,(garbage grinder)
Washing Machine
Water Heater
Floor Drain
, Sewer" ~ 1st. 50ft.
each additional 100 ft.
Water Service--lst 100 ft'-
---: each ilddi tional 100 ft.
Stonn and Rain Drain- -1st. 100 ft.
'eachaddi tional 100 ft.. '
Special Waste Connection
Sewage and Swnp PumP (e;ector)
Mobile Home -Sewer- and Water
Other ,( speci fy)
SUB-TOTAL,CMinimwn $10; 00)
1L
TOTAL FEE
, "
'" .
Type of Equipment
MErnANICAL
Number of-Each
Fee .on Each
Total
.Mechanical Permit Base Fee
, Furnace up to 100~OOOBTU/H
Furnace over 100,000 BTU/H
Clothes DFyer Vent
Bathroom Ventilation Fan .&Duct
Ran~e Hood with Mechanical Exhaust
Wood Stove '
Air Conditioner Only
Heat Pump
Floor Furnace
Gas Piping System 1 to 4 Outlets
Per ,Outlet
$ 10.00
;. .
$ 6.00
7.50
'3.00
3.00
4.50
6.00
6.00
6.00
6.00
.50
~
Other (specify)
SUB-TOTAL .
I ~ertify th~t all p~umbing wor~ ~ill be d?ne in TOTAL FEE
accordance wlth appllcableprovlslons of Oregon
Revised Statu e. Chps. 447 & 693 and applicable codes, and that no he'lp wlll be employed
un 1 es S 1 ice ec ~YAd~r ~~SJ ~ r-" ." n,.-,
Signature ~1\.IL~~te 1.7. (52., Permit issued bH.J.1~~ . ~wa.
0"
..
1"[ \.
l '
r, i' r
--.....
tiFF!... I Cj::lf",! T .i"'I{':;){CiN.,
" ,
.TL~::: 1"703331100100
, LANE COUNTY DCPT ENV MGT RECEIPT' ~
~J~[M((;AMBEI~~) ADi)R 41'7 ANDI~:RS(:)N i_.NA}
l,-!r~hl BL.DG T\'PE
. CODE (IF'F'L. i\lCJ
F-:P
(lCT I ON
pr
'~'.;p
(:1:'.
r.;F'
pr:'
BF LC 2381 PI...
r:L. 1'!Cl.. F I >::TI...lF:ES' :
i";Ff'!"1
~ 'I ji:.ii;~'
FCl<
Ct.Te.; :
S[i)I.J:
l{:lI<Ei'--1
i:":',Pf:1
h',:\
(.)
[: V. C: ;:":', U
I" .
S~LI[':D I \/
i.JS:::: i:;.: BDr;..i'"iS
,:.;:Q F'r
~~BI._I)(;S 001 ~~~~()NE~: 344
I)(\Y'S
o l.JNI"i'S 001 S'I'()f~I!~~:S
:?3D'!
EI...iC;.E:NE: )
L.OT
UNIT COST VALUATION
DI:::S'C:F: I F'T I ON
'FP
ES:T .,
NO ~ CONNECTor:..s':
MECHt,i"',) I C::i~'IL. FEE
S T (1 ''C E ;:-:: U R [: H (; r:: G E
'PL.(:1(1 CHECI< FE:E'
4 :::; . 00 Er::1CH ....
.4;';';
'J'I::'U/
~..,1 ....: ."t1
,S'I)S .:.:1 T
F:C:i(
UTH
C:OHPL.ET I ON
IS'S
'I
T/JT (:lL F'Eti: ~:,,)(.
D\TF
o :j () ~:~ ~:~ ;.:.~
" €
~~
Uti
<
2
a
c:
c:
Ie
:>
~
..
o
-~
:;
!"'
<
."
o
c;
'1 I :J
, I i
!"
'"
b
'"
0(
0:
'"
...
,~
0:
L--:-
....,.
0::
0:
'X
'\1)
I
:0 (0, nr F () -j ()"/ f: :....
CJ r;.: E: G () (1
BLI<
::?1:/(?::7
FEE
r r'.
:?::> 0"' (J()
\
'j "O()
. '1 {:) ... :~::~ ~::::
'I 11
42 ., ;.:.~ :::; C 1<