Fillable Form -5214: Plumbing Permit Application City of Happy (City of Happy Valley)

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Form -5214: Plumbing Permit Application City of Happy (City of Happy Valley)

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U.S.A. forms for City of Happy Valley

BROWSE CITY OF HAPPY VALLEY (OR) FORMS

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Plumbing Permit
Application City of Happy Valley
16000 SE Misty Drive, Happy Valley, OR 97086 Phone
(503) 783-3800 Fax (503) 658
-5214
IVR 24 Hour Inspection Request Line (888) 299-2821
Schedule Online: www.oregon-epermitting.info
( Inspections / cancellations must be made by 7:00am)
www.happyvalleyor.gov
TYPE OF WORK
New Construction
Addition/Alteration/Replacement
Demolition
Other:
CATEGORY OF CONSTRUCTION
1 & 2 Family Dwelling Commercial/Industrial Accessory Building
Multi-Family Tenant Improvement Other:
JOB SITE INFORMATION AND LOCATION
Job Site Address:
City/State/ZIP:
Subdivision or Project Name:
Lot # or Tax Map/Parcel #:
DESCRIPTION OF WORK
PROPERTY OWNER / TENANT
Name or Business Name:
Contact Name:
Address:
City/State/ZIP:
Phone: Fax:
E-mail:
APPLICANT / SITE CONTACT / HOMEOWNER
Business Name:
Contact Name:
Address:
City/State/ZIP:
Phone: Fax:
E-mail:
Home Owner Installation: This installation is being made on property that I own, which is not
intended for sale, lease, rent, or exchange. (ORS 447, 455, 479, 670, 701)
Owner Signature: __________________________________ Date:_______________
PLUMBING CONTRACTOR
Business Name:
Contact Name:
Address:
City/State/ZIP:
Phone: Fax:
E-mail:
CCB License:
Plumbing Business Lic.:
Authorized Signature:
Print Name:
Date:
FEE SCHEDULE
Qty.
Ea.
Total
New 1-2 family dwellings (includes 100 lf for each utility connection)
SFR (1) bath
$ 629.00
SFR (2) bath
$ 714.00
SFR (3) bath
$ 790.00
Each additional bath/kitchen
$ 170.00
Fire sprinkler (
sq. ft.)
Site utilities
Catch basin or area drain
$ 26.00
Drywell, leach line, or trench drain
$ 26.00
Manufactured home utilities
104.00
Manholes
$ 26.00
Rain drain
$ 26.00
Sanitary sewer (100 linear ft.)
$ 96.00
Storm sewer (100 linear ft.)
$ 96.00
Water service (100 linear ft.)
$ 96.00
Fixture or item
Backflow preventer
$ 26.00
Backwater valve
$ 26.00
Clothes washer
$ 26.00
Dishwasher
$ 26.00
Drinking fountain
$ 26.00
Ejectors/sump
$ 26.00
Expansion tank
$ 26.00
Fixture/sewer cap
$ 26.00
Floor drain/floor sink/hub
$ 26.00
Garbage disposal
$ 26.00
Hose bib
$ 26.00
Ice maker
$ 26.00
Interceptor/grease trap
$ 26.00
Medical gas (value: $
)
Primer
$ 26.00
Roof drain (commercial)
$ 26.00
Sink/basin/lavatory
$ 26.00
Tub/shower/shower pan
$ 26.00
Water closet/urinal
$ 26.00
Water heater
$ 26.00
Interior piping – per floor
$ 26.00
Other:
PLUMBING PERMT FEES
Subtotal ………………………………………………
Permit Fee…………………………($85.00 minimum)
Plan review……….. (30% of Commercial Permit Fee)
State Surcharge…………………. (12% of Permit Fee)
TOTAL PLUMBING PERMIT FEE
This permit application expires if a permit is not obtained within 180 days
after it has been accepted as complete.
Revised 6/7/16
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Form -5214: Plumbing Permit Application City of Happy (City of Happy Valley)

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Completed 3 August 2020

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