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__ <br /> rou omcE vsE <br />Received by.'~-~d ~ · <br />IDate:= ~/~2 ~/'qz~ I <br /> <br />MARION COUNTY BUILDING INSPECT~_~ ;~ <br /> <br /> 220 High S~-eet NE t/~ <br /> Salem, ~egon 97301 ~ <br /> <br />PLUMBING PERMIT APPLICATION <br />P/ease complete all Sections, 1 through 5 <br /> <br />LOCATION OF INSTALLATION <br /> <br />Phone 5884147 8:00a.m.~4;30p.m. <br /> Code-A-Phone: 588-7904 <br /> <br />q( <br /> <br />Directions <br /> <br />PERMITg ARE NON-'rR~NSPERABLE A~D ~O~.~NDAB~ <br />EXPI~ IF WORK ,S NOT STAR=D ,~ lg0 DAYS ~A~ ////, <br />OR IF WO~ iS SUSPENDED FOR I SE DAYS,"~ <br /> .............. , , <br /> <br />SITE #: <br /> MARION COUNI <br />Date: ~[i. <br /> <br />Issued by: <br /> <br />4. FE~IEDULE (Complete and enter total ill Al below) <br /> SIV N'n <br /> USE OFffI~; ~ <br /> ~W ~RA~ON ~ ADDrlION ~ ~ELOCA~ON ~ <br /> <br /> BASE FEE <br /> A. RESIDENTLa, L <br /> <br />/~%'ingle Family or multi-Family per <br />dwelling unit (each fixture) <br />New construction <br />~ Alterations <br /> Re-located structnre <br /> <br />NO, XFEE =SUM <br /> <br />$20.00 <br /> <br />~-a~ $ 9.00cfi/ga <br />--$ 9.00 <br />__$4.50 ...... <br /> <br />Contractor <br /> <br />Ptombing Board: <br /> <br />Journeyman% Plumbers No. , ~ <br />Con0~mtor's Signature: ~ <br /> FOR OWNER INSTALLATIONS <br /> <br />Mailil~g Address Phone <br /> <br />City/StatWZip <br /> <br />fi]he inst~llafion ia b~ing m~l~ oa pmp~ny [ own which is not intended for sal~, <br /> <br />Owaegs Signature <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 speeifieatians with <br />this application, <br /> <br />This optional plan review program does not suspend the <br />required subm~sslon of plans, and specifications when required <br />by the Oregon Structm:al Specialty Code. Chapter 53, <br /> <br />Rev. 7/92 <br /> <br /> Water Lines <br /> First 100 ft. Or fraction thereof <br /> For additional 100 ft. (up to <br /> maximum of $00 feet) <br /> <br /> Sewer Lines <br /> First 100 feet or fi'action thereof <br /> For additional 100 feet (up to <br /> maximum 500 feet) <br /> <br />B. COMMERCIAL (each fixtme) <br /> <br /> New constructi6n <br /> Alterations <br /> Re4ocated structure <br /> <br /> Water Lines <br /> First 100 feet or fraction thereof <br /> For additional 100 feet <br /> <br /> Sewer Lines <br /> First 100 feet or fraction thereof <br /> For additional 100 feet <br /> <br />C. LAWN SPRINKLER SYSTIS~M <br /> <br /> Each protective backflow device <br /> <br />D. OTHER (as re§uired by OSPSC and <br /> Building Offieml) <br /> <br /> / $20.00~Fz, z~ <br /> <br /> --$15.00 , <br /> <br /> / $30,00 w - <br />--$15.00 <br /> <br />__$ 9.00__ <br />--$ 9,00 <br /> $ 9.00__ <br /> <br /> .. <br />--$15.00, <br /> <br />-- --$30-0G. <br />----$15,00 ........ <br /> <br />-- $ 4.50 <br /> <br /> 5. tEES <br /> Al. Enter totaI of fees from Sec. # 4 <br /> o <br /> A2. Add $ ~ surcharge (.05 x Al) <br /> <br /> Subtotal <br /> B. Enter 25*/0 of line Al for Plan Review <br /> (.25 x Al) ifreauired ' <br /> C. Investigation ~ee{ifrequired) <br />[ TOTAL A%UN"~DUE <br />t eoeip o._ga y <br /> <br /> <br />