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1 MARION COUNTY BUILDING INSPECTION <br />VOR OFFIC USE.O YI <br /> Received by: [/5C.~-_/.~(Zg~~. 220 ~ S~eet ~ ~ .... ~ <br />l~Date'/~/~ S~, ~egon ~301 ~ ~ ~ ~ ~ ~ ~'~ <br /> Phone 588-5147 8:~ a,m, ~ 4:30 p.~: ~ofmK N~ <br /> ........ i Code-A-Phone:S88-7904 ~1 n~ ~ t 199 <br /> PLUMBING PERMITAPP?CATION I w=..,., o.,.. ' <br /> <br /> BUILDING INS~EciioN <br /> <br />1, LOCATION OF INSTALLATION <br /> <br />IohAddress c~o~- //j~ff~/~ <br />Ci~ [ Cross St <br /> <br /> 2A, CONTRACTOR INSTALLATION ONLY <br /> <br /> ................ f? o, ,,if, / o <br />,, Mailing Address 0 <br /> <br />Conttactoes License No. <br />Contmctoes Board RcS, No, ] $ob No, <br /> <br /> 2B. FOR OWNER iNSTALLATIONS <br /> <br />Mailing Address , Phone <br /> <br />City/StatefZip <br /> <br />3, PLAN REVIEW SECTION <br /> <br />We will provide plan review service if you complete Section <br />5B and submit two (2) sets of plans and specifications with <br />this application, <br /> <br />This optional plan review program does not su~pend the <br />required submission of plans, and specifications when required <br />by the Oregon Structural Specialty Code, Chapter 53, <br /> <br />big 15-45 <br /> <br />Rev, 2192 <br /> <br />4. FEE SCIIEDIJLE (Complete and ~t~i~fotal m A1 below) <br /> [] m~SiD~rrl~ ~ CO~avmRCIA~ <br /> <br /> ~w [] ~o~ ~'~>~mo~ [] mock'ace [] <br /> <br />NO, XFEE =SUM <br /> <br /> $20.00 <br /> <br /> BASE FEE <br /> A. RESIDENTIAL <br /> <br /> Single Family or multi-FaraJly per <br /> dwelling unit (each fixture) <br /> New construction -- $ 9,00- <br /> Alterations --$ 9,00 <br /> Re-located structure __$ 4.50 <br /> <br /> Water Lines <br /> First 100 ff. or fraction thereof --$20.00 <br /> For additional 100 ft. (up to <br /> maximum of S00 feet) --$15.00 <br /> <br /> Sewer Lines <br /> First 100 feet or fraction thereof --$30,00 <br /> For additional 100 feet (up to <br /> maximum 500 feet) __$15,00 <br /> <br />B. COMMERCIAL (each fixture) <br /> <br /> New construction <br /> Alterations <br /> Re4oeated structure <br /> <br /> Water Lines <br /> First 100 feet or fraction thereof -- $20.00 <br /> For additional 100 feet 1 $15.00 <br /> <br /> Sewer Lines <br /> First 100 feet or fraction thereof __ $30.00__ <br /> For additional 100 feet __ $15.00 <br /> <br />C, LAWN SPRINKLER SYSTEM <br /> <br /> Each protective backflow device <br /> <br />D, OTFIER (as reclu, ired by OSPSC and <br /> Building Officml) <br /> <br />FEES <br />Al, Enter total of fees from Sec. # 4 <br />A2. Add 5% surcharge (.05 x Al) <br /> <br /> $ 9.00 <br />._;~,l $ 9.00v~_~ ~ <br /> <br />--$ 9.00 <br /> <br />-- $ 4,50-- <br /> <br /> Subtotal <br />B. Enter 25% of line Al for Plan Review <br /> (.25 x Al) if required $ <br /> C. Investigation Fee(if required) $ <br /> <br /> TOTAL AMOUNT DUE $ '7/, <br /> <br /> <br />