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Reeeived~y: ~ ~ ~' <br /> <br /> Code-A-~oae: 588-7904 <br />PLUMBIN6 PESMIT APPLICATION '" <br /> Please complete all SecOons, ~ through 5 <br /> <br />MARiON COUNTY BUILDING INSPECTION <br /> <br /> 220 High Street NE <br /> Salem, Oregon 97301 <br /> <br />Phone 58S-5147 g;00 a.m. ~ 4;30 p,m. <br /> <br />SITE ii: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />Pe<mlt No. <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />Dir~¢tion~ <br /> <br />PEr<MITS AI~ NON-TRANSYERABLE AND NON-REFUNDABLE AND <br />EXPIP. E IF WORK IS NOT STAR-TED WITIIIN 180 DAYS OF ISSUANCE <br />OR IF WORK IS SUSPI~NDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />Mailin$ Address <br />Propez~y Owl~er ] Phone <br /> <br />Contractor% t~oard Rog. No. } ~ob No. <br /> <br />FOR OWNER INSTALLATIONS <br /> <br />'i~c installation is bclnS made on~ropetly I own wh~h i$ not in~ndc~ for sale, <br /> 3, PLAN RENEW SECTION <br /> <br />We will provide phn review service if you complete Section <br />5B and submit two (2) sets ofplaus and specifications with <br />this applicatiol% <br /> <br />TI]is optional plan review prograra does not suspend the <br />required submission of plans, and specifications when required <br />by the Oregon Structural Specialty Code, Chapter 53, <br /> <br />4C~)5-45 <br /> <br />Rev, 7/92 <br /> <br />4. FEE $C/HEDULE (Complete and enter total in A1 below) <br /> ~' RESIDENTIAL ~ COMMERCIAL <br /> USE OF STRUCTUP. E: [] <br /> <br />NO, XFEE =SUM <br /> <br />BASE FEE <br />A. iLESIDENTIAL <br /> <br /> Single Family or m~ti-Family per <br /> dwelling unit (each fixture) <br /> New conshmction - $ 9.00- <br /> Alterations $ 9.00 .... <br /> P, e4oeated stmctcce __ $ 4.50 - <br /> <br /> Water Lines <br /> First 100 ~. or fraetio,a thereof <br /> For additional I00 tL (up to <br /> maximum of 500 feeO --$15.00 . <br /> <br /> Sewer Lines <br /> First 100 feet Or fraction thereof __$30,00- .... <br /> For additional I00 feet (up to <br /> maximum 500 feet) __$15,00., <br /> <br />B. COMMERCIAL (each <br /> <br /> New co~tsm, mti6n ~ $ 9.00__ <br /> Alterations ~ $ 9.00-, <br /> Re-located structure --$ 9.00 .... <br /> <br /> Water Lines <br /> Fir~ 100 feet or fraction thereof $20.00 -- <br /> For additional 100 feet .... $15,00 <br /> <br /> Sewer Lines <br /> First 100 feet or fraction thereof __$30,00 __ <br /> For additional 100 feet $15.00 .,, <br /> <br /> C, LAWN SPRINKLER SYSTEM <br /> Each protective backflow device ----$ 4.50 ,, <br /> <br />D. OTHEP, (as required by OSPSC and <br /> Bu/lding Official) <br /> <br />5. FEES Al. Enter total of fees from Sec. # 4 <br /> A2. Add 5% sm-charge (,05 x A1 ) <br /> <br /> Subtotal <br />B, Enter 25% ofline A1 for Plan Review <br /> ~ ~ (,25'X Al) ~[require~l <br /> c. investigation Fee ([ f raqqired) <br /> <br /> TO'FAL AMOUNT DUE <br /> Receipt No. ~;~"~...~ <br /> <br /> <br />