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· I MARION COUNTY BUILDING INSPECTION <br /> FOR OFFICE~USE,ONLy <br /> <br /> Please complete all Sections, 1 through 5 <br />I ~ <br /> ..... <br /> <br />PERMITS APE NON-TP. ANSFE]R.&ELE AND NON.I~FUNDABLE AND <br />EXPIRE IF WOR~ IS NOT STARTED WITHIN 180 DAYS Olv ISSUANCE <br />OR IF WORK IS SUSPENDED FOR 180 DAYS· <br /> <br />CONTRACTOR INSTALLATION ONLY <br /> <br />FOR OWNER INSTALLATIONS <br /> <br />Prop¢~yOwncr <br /> <br />City~State~Zip <br /> <br />The inst~lhflon is being made on propcrt71 ov~n which is riel ita~nded for sale, <br /> <br />Ownees Slgnatur~ <br /> <br /> 3. PLAN REVIEW SECTION <br /> <br />us~ OF STRUCrLam: [~ <br />EI~W ~'I~AT~ON [] ADDITION ~ REI~OC~.TION [] <br /> <br />r/ <br /> <br /> BASE F~E <br /> A. RESIDENTIAL <br /> <br /> Single Family or multi-Family per <br /> dwellCg un/t (each fixture) <br /> New conslxuction <br /> Alterations <br /> Re-located struct~e <br /> <br /> Water Lines <br /> First I00 fl, or fi.action thereof <br /> For additional 100 K, (up to <br /> maximum of 500 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 fixture) <br /> <br /> New constructi6n <br /> Alteration* <br /> Re.located structure <br /> <br /> Water Lines <br /> First 100 feet or fi.action thereof <br /> For additional 100 feet <br /> <br /> Sewer Lines <br /> First 100 feet or fi.action thereof <br /> For additional 100 feet <br /> <br /> C. LAWN SPRINKLER SYSTEM <br /> <br /> Each protective backflow device <br /> <br />D, OT~ER (as re§uired by OSPSC and <br /> Building Of final) <br /> <br />NO, XEEE -SUM <br /> <br /> $20.00 <br /> <br /> --$ 9.00 <br /> $ 9.00~ <br /> __ $ 4.5o,, <br /> <br /> __$20,00 <br /> $15.0o ..... <br /> <br />__$3o,o0 <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 />__$15,o0~ <br /> <br /> ! s <br /> <br />We will provide plan review service if you complete Section <br />5B and submit two (2) sets of plans and specifications with <br />this application. <br /> <br />This optional plan review program does not suspend the <br />required submission of plans, and specifications when required <br />by the Oregon Structural Specialty Code, Chapter 53. <br /> <br />Rev, 7/92 <br /> <br />5. FEES Al, Enter total of fees from Sec, # 4 <br /> A2. Acid 5% surcharge (.05 x Al) <br /> <br /> Subtotal <br />B. Enter 25% of line A1 for Plml Review <br /> (.25 x Al) if reqnked <br /> C, Investigation Fee(if requited) <br /> <br /> TOTAN &IglOUNT DUE, <br /> <br />$ <br />$ <br /> <br /> <br />