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FOl~ OF~CE USE ONLY <br />Receded by: <br />Date: <br /> <br />PLUMBING PERMIT APPLICATION I <br />Please complete all Sections, I through 5 ~ <br /> I <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br />220 l~igh Street lie <br />~alem, Oregon 97301 <br /> <br />Phone 588-5147 8:00 nm, ~ 4:30 p,m, <br />Code-A-Phone: 555-7904 <br /> FAX: 588-7948 <br /> <br />SITE #: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />Permit No. <br /> <br />1. LOCATION OF iNSTALLATION <br /> <br />PERzV!ITS ARE NON.TRANSFERABLE AND NON-REFUNDABLE AND <br />EXPIRE IF WORK IS NOT STAP, TED WITHIN 180 DAYS OF ISSUANCE <br />OR. IF WORK iS SUSPENDED FOR 180 DAYS. <br /> <br />Jom'neyman's Plumbers No, <br />Gontractor'~ Signature: <br />2B. FOR OWNER INSTAL~ TIONS <br />P~po~y ~ner <br />~iling Add.ss phone <br /> <br />City/State/Zip <br /> <br />~ installation is bging made on pmpeay I own whkh is not intendad for sale, <br /> <br />Owners Sigaatu~ <br /> <br /> 3. PLAN REVIEW SE~ION <br /> <br />We will provide plan review service if you complete Section <br />513 ,and submit two (2) sets &plans and specifications with <br />this application, <br /> <br />This optional plan review program does not suspend the <br />reqaked submissiou of plans, and specifications when required <br />by the Oregon Structural Specialty Code, Chapter 53. <br /> <br />~1C 1.5-45 <br />Rev, 7/92 <br /> <br />4. ~ SCItEDL~E (Compte~ and eilter total in A1 Ix:low) <br /> []~m~sn)~rriAL [] COM~VnmC~AL <br /> USE OF ~U~: ~ <br /> NEW ~ON ~ ADDISON ~ ~LO~ON ~ <br /> <br />NO. XJ~E =SUM <br /> <br /> $20.00 <br /> <br />BASE FEE <br />A. RESIDENTIAL <br /> Single Family or muhi-Fami!y per <br /> dwellikg unit (each fixture) <br /> New construction I $ 9-00~00 <br /> Alterations; ,$ 9.00~ <br /> Re-located structure -~ $ 4.50 ~/-00 <br /> <br /> Water Lines <br /> First 100 fi. or fi.action thereof __$20,00 ......... <br /> For additional 100 It. (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 (ap to <br /> maximum 500 feet) __,$15.0(L____ <br /> <br />(each fixture) <br /> <br />__$ 9,00 <br />--.$ 9.00 <br />__,$ 9.00__ <br /> <br /> Re-located structure <br /> <br /> Water Lines <br /> First I00 feet or fraction thereof -- $20,00 <br /> For additional 100 feet -- $15,00 <br /> <br /> Sewer Line~ <br /> First 100 feet or fi.action thereof __.$30.00__ <br /> FOr additional 100 feet --.$15.00 <br /> <br /> LAWN SPRINKLER SYSTEM <br /> Each protective backflow device --. $ 430 <br /> <br />D, OILIER (as recluived by OSPSC and <br /> Building Offietal) <br /> <br /> 5, FEES Al. Enter total of fee~ Rom Se~, # 4 <br /> A2. Add 5% surcharge 605 x Al) <br /> <br /> Subtotal <br /> B. Enter 25% of line A1 for Plan Review <br /> (.25 xA1) if required <br /> C. Investigation Fee(i f required) <br /> D. Relnspection Fee <br /> <br /> TOTAL AMOUNT DUE <br /> <br />[ Re. ce pt No. <br /> <br /> <br />