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I I*OR OF~;IC_~ ~USE~ O~¥] MARION COUNTY BUILDING INSPECTION <br />Receive~ ~ 220 <br />Date: .~ . ~ ~-~ S~em,~egon97301 <br /> <br /> PLUMBING PERMIT APPLICATION <br /> Please complete all Sections, 1 through 5 J JU~ ~ ~ ~ Issued by; <br /> <br /> Di~etions <br /> <br /> BASE FEE <br /> <br /> PERMIT$ AP..~ NON-TR~NS~P-.ABLE; AND NON-REFUNDABLE AND <br /> EXPiR.'8 IF WORK I$ NOT STARTED WITHIN 1 S0 DAYS OF ISSUANCE <br /> ORIF WOILK IS SUSPENDED I~O]P, 180 DAYS. <br /> <br />RACTOR~NSTALLATION ONLY <br /> <br />Joomeyman's Plumbers No, <br /> <br /> 2B. FOR OWNI~R INSTALLATIONS / <br /> <br />Mailing Address /~r~ S, ~ Phone ~>~ <br /> <br /> 3. PLAN REVIEW $};CTION <br /> <br />RESIDENTIAL <br /> <br />Single Family or multi-Family per <br />dwelling unit(each fixture) <br /> New construction <br /> Altemtions <br /> Pc-located structure <br /> <br />Water Lines <br /> F/PSt I00 R. or fi.action thereof <br /> For additional 100 ft. (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 />COMMERCIAL (each fixture) · <br /> <br />New constmoti6n <br />Alterations <br />Re-located structure <br /> <br />Water Lines <br /> First I00 feet or f~cacfior~ thereof <br /> For additional I00 feet <br /> <br />Sewer Lines <br /> First 100 feet or fraction thereof <br /> For additional I00 feet <br /> <br />LAWN SPRiNIO~ER SYSTEM <br />Each protective backflow device <br /> <br />OTHER (as re~Juired by OSPSC and <br />Building Offimal) <br /> <br />NO. Xl~g~.-SLIM <br /> <br /> $20.00 <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 /> <br />--$20.00 <br />--$15.00 <br /> <br /> / $30.00..~a't <br />--$I$.00 ...... <br /> <br />4.50- <br /> <br />We will provide plan review service if you complete Section <br />5B and submit two (2) sets of plans and specifications with <br />this application. <br /> <br />This optional plan review program does not suspend the <br />required submission of plans, and specfficatmns when required <br />by the Oregon Structural Specialty Code, Chapter 53. <br /> <br />~tt: 15:45 <br />Rev. 7/92 <br /> <br />5, FF~S <br /> Al. Enter total of fees from Sec, # 4 <br /> A2. Add 5% surcharge (.05 x Al) <br /> <br /> Subtotal <br />B. Enter 25% of line A1 for Plan Review <br /> (,25 x Al) if required <br /> C. Investigation Fee 0,~r_equiged) <br /> <br /> TOTAL AMOUNT DUE <br /> <br />$ <br />$ <br /> <br /> <br />