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PLUMBING PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />Phone 588-5147 8:00a. ng~4:30p.ng SErE #: <br />Code-A-Phone: 588-7904 MARION GOUN I Y <br />~Ax: sss.7~4~ Date: m m n~la Ito_qpl:f:TlflN <br /> <br />Issued by: <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />ci~ ~a/. c/;, <br /> <br />Directions <br /> <br /> PERMITS ARE NON-TRANSFERABlE AND NON-REF~J'NDABLE AND <br /> EXPIRE IF WORK IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE <br /> OR IF WORK IS SUSPENDED FOR 180 DAYS. <br /> <br /> 2A. CONTRACTOR INSTALLATION ONLY <br /> <br /> Contractor Phone <br /> <br /> Mailing Address <br /> Properly Owner [ Phone <br /> Plumbing Board: <br /> Contntctofs Board Reg. No. Job No. <br /> Journeyman's Plumbers No. <br /> Contractor's Signature: <br /> 2B. FOR OWNER INSTALLATIONS <br /> <br />~e in~on is ~ing ~e on pm~ I o~ which is not intended for ~e, <br />le~, or ~L <br /> <br /> 3. P~N ~EW SE~ION ~ <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 Structural Specialty Code, Chapter 53. <br /> <br /> rC 15-45 <br />Rev. 7/92 <br /> <br />4. FI~~UI~ (Complete and enter total in A1 below) <br /> ~~RESIDENTIAL [-~ COMMERCIAL <br /> <br /> ~w E]At.m~uoN [] Ar~mo~ [g""~uo~ [] <br /> <br />NO. X Fgg = SUM <br /> <br /> $20.00 <br /> <br /> BASE FEE <br /> A. RESIDENTIAL <br /> <br /> Single Family or multi-Family per <br /> dwe_l~n_ g unit (each fixture) <br /> New construction ~ $ 9.00 <br /> Alterations -- $ 9.00 <br /> Re-located slmcture ~$ 4.50~ <br /> Water Lines <br /> First 100 fi. or fraction thereof ~$20.00 <br /> For additional 100 fi. (up to <br /> maximum of 500 feet) ~ $15.00 <br /> <br /> Sewer Lines <br /> First 100 feet or fraction thereof __ $30.00 <br /> For additional 100 feet (up to <br /> maxtmum 500 fee0 ~$15.00 <br /> <br />B. COMMERCIAL (each fixture) · <br /> <br /> New construction __ $ 9.00 <br /> Alterations ~ $ 9.00 <br /> Re-located slmcture __$ 9.00 <br /> <br /> Water Lines <br /> First 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. OTHER (as re~.u~r, ed by OSPSC and <br /> Building Official) <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. Investigation Fee (if requested) $ <br /> D~/~c.- $ <br /> TOTAL AMOUNT DUE $ <br /> Receipt No. 6f~y <br /> <br /> <br />