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Phone 588-5147 S;00 a.m.- 4:30 p,tn, SITE ~1 Permit No, <br /> <br /> PLUMBING PERMIT APPLICATION ] Code-^-Phone: 5 SS-7904 <br /> PAX: 588.Tg4S Date: <br />·]P/ease complete all Sections, 1 through 5 Issued ~ <br /> by: <br /> <br /> I, I~OCATION OF INSTALLATION <br />~ob Address <br /> <br />2ity <br /> <br />Cross St, <br /> <br />FERMI'rS ARE NON-TRANSFERABLE AND NON-REFUNDABLE AND <br />EXPIRE IF WORK IS NOT STARTED WI'IlliN 180 DAYS OF ISSUANCE <br />OR iF WORK IS SUSPENDED FOR 180 DAYS, <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br />Contractor I Phone <br />Mailing Address <br /> <br />Plumbing Board: <br /> <br />ContractOes Board ReS, No. <br /> <br />2]8. FOR OWNER INSTALLATIONS <br /> <br />No, <br /> <br />Pmpeay Owne£ ~O,,,e A~///(//D/ g~'/~/~'~"//'~ ~ <br /> <br />The installation is being made on property I own which is not intended for sale, <br />lease, or rent. <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 &plans and specifications with <br />this application. <br /> <br />This optional plan review program does not suspend the <br />required submission of plans, and specifications when required <br />by the Oregon Structural Specialty Code, Chapter 53. <br /> <br />IC I5-45 <br />Rev. 7/92 <br /> <br />4, FEE SCltEDUI,E (Complete and enter total in A1 below) <br /> [~J RESmENTt~U~ ~ COm~C~ <br /> USE OF Sl~U~U~: ~ <br /> ~w ~ ~'I~'nON ~ ADDI'I1ON ~ ~LO~'IION ~ <br /> <br />BASE FEE <br />A, RESIDENTIAL <br /> <br />NO, XFEE =SUM <br /> <br />Single Family or multi-Family 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 fi'action thereof <br /> For additional 100 fi. (up to <br /> maximum of 500 feet) <br /> <br />Sewer Lines <br /> First 100 feet or fraction thereof <br /> For additional 100 feet (up to <br /> maximum 500 fee0 <br /> <br />B. COMMERCIAL (each fixture) <br /> <br />New constmcti6n <br />Alterations <br />Re-located structure <br /> <br />i $:o.oo 0 <br /> <br />--$15.00 . <br /> <br />$30.00~ <br /> <br />--$15.00 <br /> <br /> $ 9,OO <br />--$ 9,00 <br />--$ 9,00 <br /> <br />Water Lines <br /> 1 <br />First 100 feet or fraction thereof I $20.00 <br />For additional 100 feet --$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. OTHER (as reguired by OSPSC and <br /> Building Officml) <br /> <br />--$4.50 <br /> <br />5. FEES Al. Enter total of fees from See, <br /> A2, Add 5% surcharge (,05 x Al) <br /> <br /> Subtotal <br />B. Enter 25 ~ ofline A1 for Plan Review <br /> 625 x Al) if required <br /> C, Investigation Fee [i f requited) <br /> D. Reinspection Fee <br /> <br /> zO ^L ^uotrar r UE <br /> <br /> <br />