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1 <br />JFOR OFFICE USE ONLY[ <br />Received by: <br />Date: ,, <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br />220 High Stxeet NE <br />Salem, Oregon 97301 <br /> <br />Phone SS8-$147 S;00 a.m.- 4:S0 p,ra, <br /> Code-A-Phone:SSS-790a <br /> ~P,X:588-7948 <br /> <br />IPLUMBING PERMIT APPLICATION <br /> Please complete all Sections, 1 through 5 <br /> <br />Date: <br /> <br />Issued by: <br /> <br />I. LOCATION OF INSTALLATION <br /> <br />PEILMITS ARE NON-TRANSFERABLE AND NON,REFUNDABLE AND <br />.EXPIRE IF WORK IS NOT STAP, TED WITHIN lg0 DAYS OF ISSUANCE <br />OR IF WORK IS SUspEnDED I~OR tS0 DAYS, <br /> <br />2A. CONTRA(Y£OR INSTALLATION ONLY <br /> <br />Ma/ling Address <br />Property Owner [ Phone <br />Plumbing Board: <br /> <br />Journeyman's Plumbers No, <br /> <br /> 2~, FOR OWNER INSTAL~TIONS <br /> <br />1~¢ installation is beinS made on property I own which is no/intended <br /> <br />Owners Sisnatur~ _ ..,,,,,: .............. - - <br /> <br />PLAN REVIEW SECTION <br /> <br />4. FEE SI~u~DLrLE (Compl~e and enter total in A1 l~low) <br />  ILESIDENTIAL [] CO~RCIAL <br /> U~ OF S~U~: ~ <br /> NEW O~ON ~ ~D~ON ~ ~ON ~ <br /> <br />BASE FEE <br />A. RESIDENTIAL <br /> <br />Single Family or multi-Family per <br />dwelling unit (each fixture) <br /> New construction <br /> Alterations <br /> Re-located structure <br /> <br />NO. X I~E = SUM <br /> <br /> $20.00 <br /> <br /> ~ .$ 9,00,,, <br />--$ 9,00-- <br />__ $ 4.50-- <br /> <br />Water Lines <br /> I <br /> ' First 100 fi. or fraction thereof I $20.00-- <br /> For additional 100 k (up to <br /> maximum of 500 feet) __ $15.00 <br /> <br />Sewer Lines <br /> , First 100 feet or fraction thereof <br /> For additional 100 feet (up to <br /> maximum 500 feet) <br /> <br />B. COMMERCIAL (each fixture) <br /> <br />New construct/on <br />Alterations <br />Re-located structure <br /> <br />Water Lines <br /> First 100 feet or fraction thereof <br /> For additional 100 feet <br /> <br />[ $30,00~ <br /> <br />__$15.00 <br /> <br />9,00 <br />9.00-- <br />9.00 <br /> <br /> $20,00-- <br />---$15.00-- <br /> <br />Sewer Lines <br />First 100 feet or fraction thereof g30.00.__ <br />For additional 100 feet --.$15.00 <br /> <br />C. LAWN SPRINKLER SYSTI~M <br /> <br />Each protective backflow device <br /> <br />D. OTHER (as required by OSPSC and <br /> Building Official) <br /> <br />4.50 <br /> <br />We will provide plan review service if you complete Section <br />5B sa~l submit two (2) sets of pluns 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 />dC 15-45 <br />Rev. 7/92 <br /> <br />5, FEES surcharge (.05 x ) <br /> Al. Enter total of fees from Sec. # 4 __'~ <br /> A2- Add 5% A1 $ <br /> <br />B, Ent~ 25% orlia4 A1 for PI~ Revi~ <br />(;~S;x'~l) if required $ <br />C, hvestiga~on F~(ifrequired) $ <br />D. Re~tfoa Fee $ <br /> TOTAL ~0~ DUE <br />Receipt No- <br /> <br /> <br />