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i~ARION COUNTY BUILD N'G NSPECTION <br />'sanst~r Bldg. No. ~,25 <br /> 220 High ~reet NE <br /> Salem Oregon 97301 <br /> <br /> Phone ;88-5147 <br /> Code-A-Phone 4:30 RM, - 8:00 A.M. <br /> <br />UARION COUNTY <br />BUILDING INSPECTION <br /> <br />PLUMBING PERMIT APPLICATION <br /> <br />Owner: Phone: Address: <br />Euf fraan 371 654 <br />Robert - 7 <br />Plumbing Installer: -- <br />~8~0624 <br />Home Builder~ Registration No , <br /> <br />Resldential:~ New: ~ . Addition: ~ Occupancy ~ UseofBulldl~g: ' <br />Commemlab~ .Ateration:'~ Rel~ation: ~Change: ~ ~ ' <br /> <br /> ' · NO. FEE AMOUNT <br /> Base Price ' ' '" $10,00 <br /> Residential 10' <br /> Ne'~construction eachfixtu, re) , , $ 7.50 ~7~ f3~' <br /> Alterations (each fixture) . 7,50 · <br /> Re-located Residence (each fixture) .. 3.75 <br /> Commercial ' <br /> New Construction eacl~ fixture '7.50 <br /> Alterations each fixture , ' ' , 7,50 <br /> <br /> WaterLines . , <br /> For the first 100 feet or fraction thereof ' <br /> 20.00 <br /> For additional 100 feet 15.00 <br /> Sewer Service Lines ' ' <br /> First 100 feet or fram[on thereof ' ' 30.'00 <br /> ,; ,~, ~, Additional 100 feet · , 15,00 <br />Lawn ~prinkling 8yst · , , , , <br />Other (as per OSPSC and Bud ng Off c al) <br />On-Site Technical Review (apply at Marion County only) <br />_Re-Inspection Fee I <br /> FEE $ ~ <br /> STATE SURCHARGE ~2,5 <br />. , PLAN REVIEW FEE $ <br />,, , DOUBLE FEE $ <br />Please return COMPLETE APPL CAT ON FLEETSURCHARGE ~ <br />~vith the indicated fee, , C~TY FEE $ <br />. TOTAL ~ <br /> <br /> I,,[,.~'rfo r ming work on a properly I own or occupy ~t <br />&--4~ I am a mgists~d builder OR t ~ the authorized representative of 81GNATURE OF APPLICAN <br /> <br /> The <br /> <br />MC 15-45 <br />Rev. 3/87 <br /> <br /> <br />