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'FOR OFF, ICE USE ONLY'I <br />Received <br /> <br /> PLUMBING pERMIT APPLICATION <br /> Please complete afl Sections, 1 through 5 <br /> <br />MARION COUNTY BUILDING S Eglt.t,9 '~1111 <br /> <br /> 220 s et <br /> S~em, ~g~ 97301 MARION CO~Ty <br /> <br /> ~o.~ ~s~-~7 moo ~ <br /> Cod~A-~oBe: 5B~-7904 <br /> <br />Issued 'by: <br /> <br />pERMITS ARE NON-TRANSFERABLE AND NON-KEFUNDABLE AND <br />F, XpI II, E IF WORK IS NOT STARTED WITHIN t gO DAYS OF ISSUANCE <br />OR Il* WORK IS SUSPIgNDED FOR 180 DAYS. <br /> <br /> lA. CONTRACTOR INSTALLATION ONLY <br /> <br />Plumbing Board; <br /> <br />Journeyman's Plumbers No, <br /> <br /> 2n, FOR OWNER INSTALLATIONS <br /> <br />Mailing Ad~f~ss Phone ~'.~/',~/D~ <br /> <br />Thc installation is being ~d* oa properly I own which is not intended for ~le, <br /> <br />Owner'~ S/gnatut,~ <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 pLm review program does not suspend the <br />required snbmJssion of plans, and specifications when required <br />by the Oregon Stmct~a! Specialty Code, Chapter 53. <br /> <br />~C 1.5,45 <br />Rev, 7/92 <br /> <br /> IeEE SCHEDULE (Complete and ~t~r total i~ A1 below) <br /> [] m, E ri <br /> COMMERCI~ <br /> <br />NEw ~A~T'~RATION ~&DDITIOlq [] 'aBIJDCATIOlq [~ <br /> <br />NO. XFEg =SUM <br /> <br />BASE FEE $20.00 <br />A. RESIDENTIAL <br /> <br />Single Family or multi-Family per <br />dwelling unit (each fixture) <br /> New construction <br /> Alterations <br /> Re.located structure <br /> <br />Water Lines <br /> First 100 fi, or fraction thereof <br /> For additional 100 fl:. (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 /> maxiraum 500 feet) <br /> <br />COMMERCIAL (each fixture) <br /> <br />New con~tructi6n <br />Atteratiotts <br />Re.located structure <br /> <br />Water Lines <br /> First I00 feet or fraction thereof <br /> For additional 100 feet <br /> <br />Sewer Lines <br /> First I00 feet Or fraction thereof <br /> For additional 100 feet <br /> <br />LAWN SPRINKLER SYSTEM <br /> <br />t~ch protective backflow device <br /> <br />OTHER (as foci _u¢~ ed by OSPSC ~a~d~ <br />Building Offie.al) <br /> <br />~ $ 9.00 -,, <br />~$ 9.00 <br /> $ 4.50~ <br /> <br />~$20.00 <br /> <br /> · $15,00 <br /> <br />__$30,00 <br /> <br /> .... $15.00 <br /> <br /> & $9.00 <br />~ $ 9,00 .... <br /> _,, $ 9.00 ..... <br /> <br />~$20.00 ..... <br />~$15.00 .... <br /> <br />~$30.00 __ <br />,, $15.00 ..... <br /> <br />- $ 4.50- <br /> <br /> Al. Enter total of fees from See, <br /> 3,2, Add 5% surcharge (.0~ x Al) <br /> <br /> Subtotal <br />B. Fmter 25% of line A1 for Plan Review <br /> (,25 X Al) il'requffed <br /> C. investigation Fee(if required) <br /> D, Rcms~ction F~ <br /> <br /> . <br /> <br /> <br />