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~OR 0FFIC,~yS?~ON~¥] <br />I Received by: ~' I :Ss Ch~h St, ~ - Room t32 <br /> $at~, O~g~ 9~301 <br /> <br /> ~ ~o ~ ) .. :~.~o~.~. <br /> III~LU~ B' ~* pER M 'T AP P L'CAT' ONto ~ i*~~~ <br /> Pl~se complete ali Sections, 1 thr~ 5~}U~ 0 ~ 1~95 ~ <br /> <br />L LOCATION OF IN$TALLATION <br /> <br />/ <br /> <br />MARION COUNTY BUILDING INSPECTION <br />COMMUNITY DI~VELOPMENT CENTER <br /> <br /> SITE ~: <br /> Date: <br /> Issued by: <br /> <br /> MARION COUf ITY <br />BUILDING INSP 211( <br /> <br />Dkccfiona <br /> <br />PI~RaMI TS AP, E NON-TRANSFERABLE AND NON-REFUNDABLE AND <br />EXPIRE [F WORK IS NOT STARTLED WITHIN 180 DAYS OF ISSUANCE <br />OR IF WORK IS SUSPENDED FOR 180 DAYS, <br /> <br />lA. CONT P. ACTOI~, INSTALLAXION ONLY <br /> <br />Phone <br /> <br />Mailing Address <br />Poope~y Owner [ Phone <br />Plumbing Board: <br />Contractors Board Reg, No, ] lob No. <br />Journeyman's Plum~ No. <br /> <br />The installation is being made on property I own which is not intended for sale, <br /> <br />,,Owner's .... Signalur* .... t <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 prograra does not suspend the <br />required submission of plans, and specifications when required <br />by the Oregou Structural Specialty Code, Chapter 53. <br /> <br />MC 15-4~ <br />Rev. 8/94 <br /> <br />PermR No. <br /> <br />4. FE~,~,DLILE (Coraplete alld enter total in A1 below) <br /> L~I RESIDENTIAL ~ COMMERCIAL <br /> <br /> ~£w ~ALmXlOIq ~M)m~o~q ~//m~LOCnaXO/q [~ <br /> <br /> IASE FEE <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 ff. Or fraction thereof <br /> For additional 100 t~, (up to <br /> maximum ors00 feet) <br /> <br /> Sewer Lines <br /> First 100 feet or fraction thereof <br /> For additional 100 feet (up to <br /> maximum 500 feet) <br /> <br />B. COMMERCIAL (each fixture) <br /> <br /> New construct/On <br /> Alterations <br /> Re4ocated smacture <br /> <br /> Water Lines <br /> First 100 feet or fraction thereof <br /> For additional 100 feet <br /> <br /> Sewer Lines <br /> Fi~t 100 feet or fraction thereof <br /> FOr additional I00 feet <br /> <br />C. I~WN SPRINKLER SYSTEM <br /> <br /> Each proteotive hackflow device <br /> <br />D. OTHER (as re§~red by OSPSC and <br /> Building Officml) <br /> <br />FEE - SUM <br /> $20,00 <br /> <br />--.S 9.00 'I I <br />--.$ 9,00~ <br />__.$ 4.50 <br /> <br />__,$20,00 <br /> <br />5. FEES Al. Enter total of fees from Sec. <br /> A2, Add 5% surcharge (.05 x Al) <br /> <br /> Subtotal <br />B. Enter 25% oflin~ Al for Plan Review' <br /> (.25 x Al) il'required <br /> C. Investigation Feeiifreouired) <br /> <br /> TOTAL AMOTJNT DIJE <br /> <br />$15.00 <br /> <br />--.$30.00 , <br /> <br />__,$ 9.00 <br />--.$ 9.00 <br /> <br />__~$ 9,00 <br /> <br />~$20,00 <br />--$15.00 <br /> <br />--.$30.00 <br /> <br /> <br />