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FOR OI~FICE USE ONLY MARION COUNTY BUILDING INSPECTION <br />Received by: 220 High Slreet NE <br />Date: Salem, Oregon 97301 <br /> ~ ..?_:~S~7;, SITE #: <br /> <br />Please complete all Sections, I throc~tP5L ~, I * ~. ~'~ <br /> I~j~ ~ ' Issued by: <br /> <br />Dimctloas <br /> <br />PERlvilTS ARE NON-TRANsFERABLE AND NON-REFUNDABLE AND <br />EXPIRE IF WORK IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE <br />OR IF WORK IS SUSPENDED FOR 180 DAYS, <br /> <br />Prope~W Owner <br />Mailing Address [ Phone <br />City/Stet~/Zip <br /> <br />The installation is being m~le on property I own which is not intended for <br />leaze, or r~nt. <br /> <br />Ov~efs Signature <br /> <br /> 3. PLAN REVIEW SECTION <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 />~IC 15-45 <br />Rev. 7/92 <br /> <br />Permit No, <br /> <br /> E SC~ ~I~ULE (Complete and anter total in Al below) <br /> <br /> I I RESIDENTIAL I I COMMERCIAL <br />U~ OF gI~.UL-TUI~: [] <br /> <br />~w O~m~uo. [] ~nmo. [] ~mC. AUO~ [] <br /> <br />BASE FEE <br />A. R~SIDENTIAL <br /> <br />Single Family or multi-Family per <br />dwelling unit (each fixture) · <br />New construction --$ 9.00 <br />Alterations --$ 9.00 <br />Re-located structure __$ 4.50 <br /> <br />Water Lines <br />First 100 ff. or fraction thereof --$20.00 <br />For additional 100 ff. (up to <br />maximum of 500 feet) --$15.00 <br /> <br />Sewer Lines <br />First 100 feet or fraction thereof --$30.00 <br />For a. dditional 100 feet(up to <br /> maximum 500 feet) --$15.00 <br /> <br />B. COMMERCIAL (each fixture) <br /> <br />New constructi6n __ $ 9.00 <br />Alterations · <br /> ,%':; --$ -- $ 9.009.00 <br />Re-located <br /> sfruc!! <br />Water Lines <br /> First 100 ., 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 SYSI'EIVl <br /> <br />Each protective backflow device <br /> <br />D. OTHER (as reg.mr,' ed by OSPSC and <br /> Building Offictal) <br /> <br />5. FEES <br /> Al. Enter total of fees from Sec. # 4 <br /> .4.2. Add 5% surcharge (.05 x Al) <br /> <br /> ~O <br />~ ~?.5. <br /> <br /> Subtotal $ <br />B. Enter 25% of line A1 for Plan Review <br /> (.25 x Al) if reqmred $ <br /> C. Investigation Fee (if required) $ <br /> D. Reinspection Fee $ <br /> 7 3 <br /> Receipt No. <br /> <br /> <br />