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~ Received by: __.. <br /> Date: -. <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br />220 High Street NE <br />Salem, Oregon 97301 <br /> <br /> Phoa~ 588.5147 8:00 a.m.-4:30 p.m, SITE #: <br /> Cod¢-A-Fhon¢: 588-7904 <br />IPLUMBING PERMIT APPLICATION ] v.~t: 588-,o48 Date: <br />Please complete all Sections, 1 through 5 Issued by: <br /> <br />Permit No. <br /> <br />1, LOCATION OF INSTALI~TION <br /> <br />~'ob Address ~*~,~ '~ 7 <br /> <br />PERMITS ARE NON-'I'RANSF~RABLE AND NON-REFLrNDABLE AND <br />EX?IIEE II" WORK IS NOr STARTED W1T~IYN 180 DAYS OF ISSUANCE <br />OR IF WORK IS SUSPF~NDED FOP. 180 DAYS, <br /> <br />CONTRACTOR INSTALLATION ONLY <br /> <br />MailingAdd~ss ~-0, ~V'~ <br />Propcay Owner ']' Phone <br /> <br />co.,.¢,oe, So.,d R.S. xo. ~"//-/~9 I '°~ xo, <br /> <br />Journeyman's Plarnbors No. ~.~- ~.~f d/~) <br /> FOR OWNER IN$'rALLATIONS <br /> <br />Mailing Addross [ Phone <br />City/State/Zip <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 plm~ review program does not suspend the <br />~equired submission of p]tms, and specifications when required <br />by the Oregon Structural Specialty Code, Chapter 53. <br /> <br />'C 15-45' <br /> <br />Rev, 7192 <br /> <br />4. FEE S~dI:U~ULE (Complete and ~mter total in A1 below) <br /> [] P, ESIDErCrIAL [7~] CO~aCIAL <br /> Uss OF S~U~; ~ <br /> NEW O AL~U0N ~ ADDISON ~ ~O~ON~ <br /> <br />NO. XFEE 'SUM <br /> <br />BASE FEE $20.00 <br />A, KESIDENTIAL <br /> <br />Single Family or multi-Family per ~ ,,r~/~ ~ <br />dwelling unit (each fixture) ~2~ $ 9.00.~, <br />New construction <br /> Alterations --.$ 9.00 <br /> Re-located structure __$ 4.50 <br /> <br />Water Lines <br />First 100 fi. ur fraction thereof __$20.00 <br />For additional 100 fi, (up to <br />maximum of 500 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 __ $ 9,00 <br />Alterations -- $ 9,00 <br />Re-located structure __$ 9.00 <br /> <br />Water Lines <br />First 100 feet or fraction thereof -- $20.00 <br />For additional 100 feet -- 5115.00 <br /> <br />Sewer Lines <br />First 100 feet or fraction thereof __$30,00 <br />For additional 100 feet __$15,00 .... <br /> <br />C, LA~rN SPRINKLER SYSTEM <br /> <br />Each protective backflow device <br /> <br />D. OTHER (as recjuired by OSPSC and <br /> Building Officml) <br /> <br />-- $ 4,50,,, <br /> <br />5, FEES Al. Enter total of fees from Sec. # 4 <br /> A2. Add 5% Surcharge (,05 x Al) <br /> <br /> $ <br /> <br /> Subtotal $ <br />B- Enter 25% ofllne A1 for Plan Rvvicw ....... <br /> 625 xA1) if required $ <br /> C. Investigation Fee[if required) $ <br /> D. Reinspection Fee $ <br /> <br /> TOTAl, AMou~r DUE $ <br /> Receipt No, <br /> <br /> <br />