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PLUMBING PERMIT APPLICATION <br />Please complete all Sections, 1 through 5 <br /> <br /> LOCATION OF INSTALLATION <br />JobAdd~,, 1,30 £~K~' 5 7~ <br /> <br />COUNTY,B. IJ L~ING INSPECTION <br /> <br /> ~ ssa-~RlON COU~: <br /> 8UJ~ING JNSPE~ ~: <br /> <br /> 4. ~E ~ (Co~pl~e ~d ~t~ to~ iu A1 ~low) <br /> <br />PER2vfITS ARE NON.TRANSFgRABLF. AND NON-~DABLI~ AND <br />EX PIPdg IF WORK IS NOT STARTLED WITHIN 180 DAYS OF ISSUANCE <br />OR. IF WORK IS SUSPENDt~D FOR. 180 DAYS, <br /> <br /> 2A, CONTRACTOR INSTALLATION ONLY <br /> <br />Mailing Address <br />Propet~y Owner [ Phone <br />Plumbing Board: <br /> <br />FOR OWNER INSTALLATIONS <br /> <br />Maili"gAddress ?"d' ~ a~ , ~ Phone <br /> <br />3, PLAN REVIEW SECTION <br /> <br />We will provide plan review service if you complete Section <br />5B mtd 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 &plans, and specifications when required <br />by the Oregon Structural Specialty Code, Chapter 53. <br /> <br />~dC 15-4J <br />!ev, 7/92 <br /> <br />]~ASE FEE <br />A, I~SIDENTIAL <br /> <br />S/ngle Family or multi-Family per <br />dwelli~ udit (each fixture) <br /> New construction <br /> Alterations <br /> Re-located structure <br /> <br />Water Lines <br /> First 100 ti, or fraction thereof <br /> For additional 100 Ii. (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 />Permit No. <br /> <br />NO, XFEE 'SUM <br /> <br /> $20,00 <br /> <br /> ~$ 9,00-~,..,~ <br /> $ 9,00~ <br /> ~$ 4.50 <br /> <br /> '% $20.00 ® <br /> .$15.00 <br /> <br />'% <br />__$15.00 <br /> <br />New consUmcti6n __ $ 9.00 <br />Alterations --$ 9,00 <br />Re-located stmoture .... $ 9.00 <br /> <br />--$20.00 <br />~$15,00 <br /> <br />Water L/nos <br /> First 100 feet or fraction them& <br /> For additional 100 feet <br /> <br />Sewer Lines <br />First 100 feet or fraction thereof .$30.00 ..... <br />For additional 100 feet $15.00., <br /> <br />C. LAWN SPRINKLER SYSTEM <br /> <br />Each protective backflow device <br /> <br />--$ 4.50 .... <br /> <br />D. OTHER (as reguired by OSPSC and <br /> Building Offictal) <br /> <br />FEES <br />Al, Enter total of fees from Sec, # 4 <br />A2. Add 5% surcharge (.05 x Al) <br /> <br /> Subtotal <br />Enter 25% of line A1 for Platt Review <br /> (.25 x Al) ifr~tgimd <br />C, ~vestigation Fee (ifr~tuired) <br /> <br /> <br />