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FOR OFFIC} .IJ$~E O/NLY <br />Received by: ~ <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br />PLUMBING PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />J m96 <br /> <br /> 220 High Street NE <br />Salem, Oregon 97301 <br /> <br />Phone 588-5147 $.'00 a.m. ~ 4:30 p.m. <br />Code-A-Phone: 588-7904 <br /> FAX: 588-7948 <br /> <br />SITE #: <br /> <br />Date: <br /> <br />Issued by: <br /> <br /> M/ti'IION COUNTY <br />Bllll I')!N$ Ir,~eor',','r,,-,,, <br /> <br />1. LOCATION OF INSTALLATION , <br /> <br />Directions <br /> <br /> P~ ~ NON-~NS~LE AND NON-~ABLE A~ <br /> ~ ~ WO~ IS NOT ST~D ~ 180 DAYS OF I~UANCE <br /> OR IF WO~ IS SUSP~DED ~R 180 DAYS. <br /> <br /> lA. CO~OR IN~~ON O~Y <br /> <br />Contr~tor ' <br /> <br />Mailins Address <br /> <br />Prope~y Owner <br /> <br />Phone <br /> <br />Plumbing Board: ~),~. ~t~ <br />loumeyman's Plumbem No. <br /> <br />lob No. <br /> <br />Contractor' s Signature: ~r'7"~$_~ 0 <br /> 2B. FOR OWNER INSTALLATIONS <br /> <br />Property Owner <br />Mailing Addgss [ Phone <br />City/State/Zip <br /> <br />The ins~ailntion is being made on property I own which is not intended for sale, <br />lesse, or r~nL <br /> <br />OwneFs Signnture <br /> <br /> 3. PLAN REVIEW SECTION <br /> <br />4. FEE SCi~.I}ULE (Complete and ~ total in A1 below) <br /> USE OF STRUCTURE: [] <br /> <br />BASE FEE <br />A. RESIDEN'HAL <br /> <br /> Single Family or multi-Family per <br /> dwel_'_l~ng unit (each fixture) <br /> New comtruction ~$ 9.00.. <br /> Alterations ~ $ 9.00 <br /> Re-located structure ~$ 4.50 <br /> <br /> Water Li~es <br /> First 100 fl. or fraction thereof ~$20.00 <br /> For additional lo0 -ti. (up to <br /> maximum of S00 feet) ~$15.00 <br /> <br /> Sewer Lines <br /> First 100 feet or fraction thereof ~,$30.O0 <br /> For additional 100 feet (up to <br /> maximum 500 feet) ~$15.O0 <br /> <br />B. COMMERCIAL (each fixture) . <br /> <br /> New construction <br /> Alterations <br /> Re-located structure <br /> <br /> Water Lines <br /> First 100 feet or fraction thereof _ $20.00 <br /> For additional 1 O0 feet -- $15.00 <br /> <br /> Sewer Lines <br /> First 100 feet or fraction thereof ~$30.O0 <br /> For additional 100 feet ~$15.00 <br /> <br /> LAWN SPRINKLER SYSTEM <br /> <br /> Each protective backflow device ~ $ 4.50, <br /> OTHER (as re9 .u~r. ed b'y OSPSC and <br /> Building Official) <br /> <br />NO. XI~E =SUM <br /> <br /> . $20.00 <br /> <br />9.OO <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 S, tructural Specialty Code, Chapter 53. <br /> <br />~IC 15-45 <br />Rev. 7/92 <br /> <br />5. FEES <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. _In0.~ (if required) $ <br /> ~pection F~ ~'~-, $ <br /> TOTAL AMOUNT DUE $ <br /> Receipt No. ~ 7 7 I~ <br /> <br /> <br />