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MARION COUNTY BUILDING INSPECTION <br /> <br />PLUMBING PERMIT APPLICATION <br />Please complete all Sections, 1 through 5 <br /> <br /> 1, LOCATION O~' INSTALLATION <br /> <br />220 High SWeet NE <br />Salem, Oregon 97301 <br /> <br />Phone 588-5147 g;00 a.m. - 4;30 p.m. SITE #: Permit No. <br /> <br /> F~: 588-7948 D~: <br /> Issued <br /> <br />PEP~MITS ARE NON-TRANSFeRABLE AND NON-REFLrNDABLE AND <br />EXPIRE IF WORK lS NOT STARTED 'WlTI-I IN I gO DAYS OF ISSUANCE <br />OR IF WORK IS SUSPENDED FOR 180 DAYS, <br /> <br /> 2A, CONTI~tCTOR INSTALLATION ONLy <br /> <br /> 2B. FOR OWNER INSTALLATIONS <br /> <br />Propeay Owner <br />Mailing Address } Phone <br />Cily/Stat~/Zip <br /> <br />The installation is being male on propeUy I own which is not i~tended for sale, <br /> <br />Owner's 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 specifications with <br />this application, <br /> <br />This optional plan review program does not suspend the <br />required submission of plans, and specifications when requh-ed <br />by the Oregon Structural Specialty Code, Chapter 53. <br /> <br />Rev, 7192 <br /> <br />NO. X FEE - SUM <br /> <br /> $20.00 <br /> <br /> BASE FEE <br /> A. RESIDENTIAL <br /> <br /> Single Family or multi-Family per <br /> dwelling unit (each fixture) <br /> New construction --$ 9.00 <br /> Alterations --$ 9.00 <br /> Re-located s~ucture __ $ 4.50 <br /> <br /> Water Lines <br /> First 100 R. or fi.action thereof I $20.00,,~I1'°0 <br /> For additional 100 It. (up to <br /> maximum orS00 feet) --$15,00 <br /> <br /> Sewer L/acs <br /> First 100 feet or fi.action 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 Constructi6n <br /> Alterations <br /> Re-located stmcinre <br /> <br /> Water Lines <br /> First 100 feet or fraction them& -- $20.00 · <br /> For additional 100 feet --$15.00 <br /> <br /> Sewer Lines <br /> First 100 feet or fi'action thereof --.$30.00 <br /> For additional 100 feet --.$15,00 <br /> <br /> C. LAWN SPRINKLER SYSTEM <br /> Each protective backflow device --$ 4.50 <br /> <br />D, OTHER (as required by OSPSC and <br /> Bailding Official) <br /> <br />__ $ 9.00 <br />-- $ 9.00 <br />--,$ 9.00__ <br /> <br />5. FEES Al. Enter total of fees from Sec. # 4 <br /> A2, Add 3% surcharge (.05 x Al) <br /> <br /> Subtotal $ <br />B. Enter 25% of line A1 for Plan Review <br /> (,25 x Al) frequired $ <br /> C. investigation Fee(i f requffed) $ <br />I Dc~s~ee $ _tO O0 <br /> <br /> <br />