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FOR' OFFICE USE ONLY <br />Received by: ~ <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br />PLUMBING PERMIT APPLICATION I <br />Please complete all Sections, 1 through 5 <br /> I <br /> <br />220 l-l/gh Sa-eet NE <br />Salem, Oregon 97301 <br /> <br />Phonc588-S147 8:00a. m,-4;30p.rm SITE#: <br />Cod¢-A-~hon¢: 588-7904 <br /> FAX: 555.794S Date: <br /> <br /> l. LOCATION OF INSTALLATION <br /> <br />P~TS A~ NON-~N$~BLE AND NON-~DAB~ AND <br /> <br />OR IF WO~ IS SUSp~DED FOR 18o DAYS, <br /> <br />CONTRACTOR INSTALLATION ONLY <br /> <br /> 2B, FOR OWNER INSTALLATIONS <br /> <br />pr0peay Owner <br />Mailing Address [ rhone <br />City/State/Zip <br /> <br />The installation is being made on pmpclay I own which is not intended for sale, <br /> <br /> 31 ,P~;VIEW SECT/ON <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 su~end the <br /> required submission of plans, and specifications when required <br /> b7 the Oregon Stmetnral Specialty Code, Clmpter 53. <br /> <br />MC 15-45 <br /> <br />Rev. 7/92 <br /> <br />Permit No, <br /> <br />Issued by: <br /> <br />4. ~ S~ltI~I)ULE (Complete and enter total m A1 below) <br /> [] RESIDENTIAL f~ COMMERCIAL <br /> <br />BASE FEE <br />A. P,.~SIDENTIAL <br /> <br />$20.00 <br /> <br />Single Family or multi-Family per <br />dwelling unit (each fixture) <br />~ew comtmction I '2~ $ 9,00, [~" <br />Alterations --.$ 9.00 <br />Re4ocated structure __,$ 4.50 <br /> <br />Water Lines <br /> First 100 fi, or fi.action thereof <br /> For additional 100 ft. (up to <br /> maximum of 500 feet) <br /> <br />~$20,00 <br /> <br />--$15.00-,, <br /> <br />Sewer Lines <br />First 100 feet or fraction thereof __ $30.00, <br />For additional 100 feet (rip to <br /> max/mum 500 feet) ~$15,00 <br /> <br />B. COMMERCIAL (each fixture) <br /> <br />New constmcti6n $ 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 --$15,00 <br /> <br />Sewer Lines <br /> First 100 feet or fraction thereof <br /> For additional 100 feet <br /> <br />C, LAWN SPRINKLER SYSTEM <br /> <br />Each protective backflow device <br /> <br />D, OTHER (as rec. luired by OSPSC and <br /> Building Offical) <br /> <br />__$30,00 <br />--$15,00-. <br /> <br />--$ 4,50 <br /> <br />5. FEES Al, Enter totaloffees fromSec.# 4 <br /> A2, Add 5% surcharge (.05 x Al) <br /> <br /> Subtotal <br />B, Enter 25% of line A1 for Plan Review <br /> (.25 x Al) i~re0uired <br /> C- investigation t'ee {i f required) <br /> D. R~:i spection Fcc <br /> Q~'[ ~AMOUNT DUB <br /> Receipt No. ~ <br /> <br /> <br />