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Situs Address: <br /> <br />PlumPing installer: ~._~ <br /> <br />Home Builde'r'~;' Reglstratio~No.: <br /> <br /> MA.,o. CO .W.U LD .a .SPECT,O. <br />Received By~ I~ V~/.[m Senator laldg, No. ~ <br /> <br /> ~" O~i~ ~ .~ PERMITAppLICATION <br /> Address: <br /> <br /> Phone: Address: <br /> <br />Residentlah ~ } New: ~ Addition: [] <br />Commerslal: [] J~'{)4~ Alteration: [] Relocation: [] <br /> <br />Occupancy Use of Building; <br />Change: [] <br /> <br /> NO, FEE AMOUNT <br /> Sase Price $10,00 <br /> Resideotial <br /> ............... New construction (each fixture) ............. $ 7.50 <br /> Alterations (each fixture) 7.50 <br /> <br /> ..... .R,,~;l~cated Residence (each fixture) 3.75 <br /> Commemial <br /> New Construction (each fixture) 7,50 <br /> Alteratlon.$ (e.~ch fixture) , 7.50 <br /> Water Lines <br /> For the first 100 feet or fraction thereof 20,00 <br /> For additional 100 feet 15,00 <br /> Sewer Service Lines <br /> First 100 feet or fraction thereof 30.00 <br /> Additional 100 feet 15.00 <br /> Lawn Sp[!hkling System <br /> To and Including each protective device 5,00 <br /> Other (as per OSPSC and Building Official) <br /> OmSite Technical Review (app y at Mar on County on ~! ............ <br /> Re-lnspectlon Fg=e' ......... <br /> ~E~ <br /> STATE SURCHARGE <br /> PLAN REVIEW FEE $ <br /> DOUBLE FEE $ <br />Ptea$e return COMPLETE APPLICATION FLEET SURCHARGE $ <br />with the indicated fee. CITYFEE $ <br />TOTAL <br /> <br />( ,,~ lamperformlngworko~apmpenylownoroccupy. <br /> I am a registered builder OR ( ) the authod;led representative of <br /> a registered builder. <br /> The work will be pedormed by a registered buiide[ <br /> Other <br />( ~ [~greet~in~a~c~d~n~t~the~bm~tted~ansandspe~ificat~ns`the~aws~fthestate~f~reg~nandthe~d~nan~es~fM~d~nC~unty~ <br /> <br />SIGNATUREOFAPPL[CANT: ~ ~ <br /> <br />MC 15-45 <br />Rev, $187 <br /> <br /> <br />