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FOR. OFFICE USE ONLY <br /> Recoved by: <br />[Datc:_~. <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br />220 High Street NE <br />Salem, Oregon 97301 <br /> <br />PLUMBING PERMIT APPLICATION <br />Please complete ell Sections, 1 through 5 <br /> <br />Phone 5SS-5147 8:00 a,m. ~ 4:30 p,m, <br />Code-A-Phone: 588-7904 <br /> FAX: 588.794tl <br /> <br />SITE #: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />Permit No, <br /> <br />1, LOCATION OF INSTALLATION <br /> <br />Dir¢¢lions <br /> <br />PERMITS ARE NON-'I'RANSFI'2RABLE AND NON-tLEFUNDABLE AND <br />EXPIRE 11: WORK IS NOT STARTED wrIlIIN 180 DAYS OF ISSUANCE <br />OR IF WORK IS SUSPENDED FOR 180 DAYS, <br /> <br /> 2A. CONTRACTOR INSTALLATION ONLY <br /> <br />Coniraetor Judson's, Inc. ] Ph°ne363-4141 <br /> <br />MzilingAihlr~ss P.O. ~DX 12669 Salera! OR 97309 <br />PropedyOwner ~a~'~. [ Phone <br /> <br />l'lmnblng Boa,'d: 24-22PB <br /> <br />Conlmctot'sBoard Res, No, 34604 <br /> <br />-Job No, <br /> <br />ey s Plu ~ hers N . 929JP <br /> <br /> FOR OWNER I~TALLATION$ <br /> <br />Prop¢lW Owner <br /> <br />Mailing Address Phone <br /> <br />lbo installalion ia being made on properly I owr~ which is not intended for sale, <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 opdoual plan review program does not suspend the <br />required submission of plans and specifications when required <br />by the Oregon Structnral Specialty Code, Chapter 53. <br /> <br />4C 1,5-45 <br />Rev. 7/92 <br /> <br />4. FEE SCItEDULE (Complete and enter total in Al below) <br /> 1~ RESIDENTIAL [] COMMERCIAL <br /> use OF STRUCTURE'. [] <br /> NEW ~]AL'IERATION {~[ADDIrlON [] 1LELOCATION [] <br /> <br />BASE FEE <br />A. KESIDENTIAI, <br /> <br />Single Family or multi-Family per <br />dwelling mdt (each fixture) <br /> New construction <br /> Alterations <br /> Re-located structure <br /> <br />NO, XFlgg =SUM <br /> <br /> $20.00 <br /> <br /> 7- $ 9,00 <br />__.$4.50__ <br /> <br />Water Lines <br />First 100 ~, or fraction thereof __$20.00 <br />For additional 100 fi. (up to <br />maximum of S00 feel) --$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 />$30,00 <br />___$15,00.___. <br /> <br />New construction __ $ 9,00.__ <br />Alterations -- $ 9,00 <br />Re-located structure __ 51 9.00 <br /> <br />Water Lines <br />First 100 feet Or fraction thereof --$20.00 , <br />For additional 100 feet --,$15.00 <br /> <br />Sewer Lines <br />First 100 feet or fi.action thereof __.$30.00__ <br />For additional 100 feet --.$15.00 <br /> <br />C. LAWN SPRINKLER SYSTEM <br /> <br />Each protective backflow device <br /> <br />D, OTIIER (as required by OSPSC and <br /> Building Official) <br /> <br />--.$ 4.50 <br /> <br />Receipt No. <br /> <br />5. FEES <br />Al, Enter total of fees from Sec, # 4 <br />A2, Add 5% snrcharge (.05 x Al) $ ..... ~.',' ~d <br /> <br /> Subtotal $ <br />B. Enter 25% of line Al for Plan Review <br /> ~ (,25 x Al) il-required $ <br /> C. Investigation Poe(if required) $ <br /> D, Rcinspection Fee $ <br /> TOTAl. AMOUNT DUE $ %~ ~/0 <br /> <br /> <br />