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.... I S~em, OR ~301 <br /> <br /> [ 24 hr. laspecfion Li~e 3T3-442T ~111/~.~ION <br /> ~ I ~ce: Phone S88-S14T 8:~gam - 4:3OpmU~'~~-~, ~J <br /> <br />PLU~ <br /> PERMIT <br /> APPLICA~ON <br /> <br /> ' ~~ ~ co~c~ ~ <br /> <br />1. LOCATION OF INRYALLATION <br /> <br />Cross St~ee~/Direction~: <br /> <br />ZA. CONTRACTOR INSTALLATION ONLY <br /> <br />Co~lraetor'sBoardmg. No. OL/ ~qq } lobNo. <br />,Ioumey m~n's Plumber~ Ho. ~ 3103'p <br /> <br />2B. FOR OWNER INSTALLATIONS <br />l~opeay owner (v/e~ ~e print) <br /> <br />Mailing Addreas I Phone <br />City/State/Zip <br />Owner's Sisnature: <br /> <br />Agent's Signatare: <br /> <br />USE OF STRUCTURE: <br />NEW r~ ALTERATION n ADDITION D RELOCATION <br /> <br />BASE FEE <br /> <br />R~IDENTIAL (each fL~ture) <br /> At.om ~elii~ PI~ Fee <br /> <br />S~gle F~y ~ multi-famil~ per <br /> Alte~fiom <br /> <br />No. X F~ <br />--.gl. ft. x $.070 <br /> <br />$10.00 <br />$10.00 <br />$ 5.O0 <br />$ 5.00 -- <br />$ 5.00 <br /> <br />Water Lines <br /> First 100 ft. or fraction thereof <br /> For ea. addnl' 100 ft. (up to <br /> maximum of 500 fl,) <br /> <br />Sanitmy & Storm Lines <br /> First I00 ft. or fraction <br /> For addnl' 100 ft. (up to <br /> maximum of 500 ft.) <br /> <br />COMMERCIAL (each fixture) <br /> <br /> New construction <br /> Altarations <br /> Reconnect <br /> <br />$'20.00 __ <br />$15.00 __ <br /> <br />$30.00 <br /> <br />$15.00 <br /> <br />$10.00 -- <br />$10.00 <br />$10.00 <br /> <br />For ea. addnl' 100 ft. <br /> <br />$25.00 <br /> <br />$15.00 -- <br /> <br />Sanitary & Storm L~ <br /> Fi~t 160 ft. or fraetioa thereof <br /> For addtd' tO0 ft. <br /> <br />$30.00 <br /> <br />$15.0o <br /> <br />PROTECTIVE BACKFLOW DEVICE <br />Lawn vacuum breaker (sprinkler system)__ $ 4.~0 <br />All othe~ $10,00 <br /> <br />OTHER (~s required by OSP~C <br /> ami Building O~cia0 <br /> <br />DWELLING PERM1T LABEL # of Labels N/C <br /> <br />3. PLANRBVIBW SECTION <br /> <br />Marion County does not require a plan review. <br />We will provide plan review service if you complete <br />Section 5B and submit two (2) sets of plans and <br />specifications with this application. <br /> <br />MC 15-45 <br />Rev. ID6 <br /> <br />5. FEES <br /> At. Enter total of fe~a from S~.//4 <br /> A2. Add 5% surcharge (.05 x Al) <br /> ~bt~al <br /> <br /> B. ~tcr 25~ of l~e A t ~or Plnn R~ie~ <br /> <br /> C. ~v~tign~on Fee (ff~u~d) <br /> <br /> ~T~ ~O~ D~ <br /> Ro~ipt No. <br /> <br /> <br />