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FOR OFFICE USE ONLY <br />Received bf: _ <br /> <br />MARION COUNTY BUII~DING INSPECTION <br /> <br />220 High S~reet NE <br />Salem, Oregon 97301 <br /> <br /> Phone 588-5147 8:00 a,m,-4:30 p,m, SITE #: <br /> Code-A-phone: sgs-790a <br />PLUMBING PERMIT APPLICATION I VA~: SSS-794S Date: <br />Please complete all Sections, 1 fftrough $ <br /> <br />Permit No. <br /> <br />LOCATION OF INSTALLATION <br /> <br />Directions <br /> <br /> I <br /> <br /> I <br />PERMITS ARE NON-TRANSFERABLE AND NON-REFUNDABLE AND I <br />EXPIR~ IF WORK I$ NOT STARTED WITHIN 1 ~0 DAYS OF ISSUANCE <br />OR IF WO~ IS SUSPENDED FOR 180 DAYS, <br /> <br /> 2A. CONT~OR INSTALLATION ONLY <br /> <br />Mailing Address <br /> <br />c'tv/s~/zi~ ~,C~'/l~ O~ , ¢7'3&/~ <br />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 />T,his optiotml plan review program does not suspend the. <br />required submission &plans, and specifications when required <br />bY the O~egon Structural Specialty Code, Chapter 53, <br /> <br />- Rev. 7/92 <br /> <br />4. FEE SClllgDI.~E (Compile and cater total in A1 below) <br /> ~ V, ESme)qr~A[ [] CO~m~C~A~ <br /> <br /> USE OF STRUCtuRE: ~ <br /> ~W ~AL~ON ~ ADDISON ~ KELO~ON ~ <br /> <br />NO. X F}gE ~ SUM <br /> <br />BASE FEE $20.00 <br />A, RESIDENTIAL <br /> <br />Single Family Or multi-Family per <br />dwelling milt (each fixture) <br /> New construction <br /> Altemtibns <br /> Re.located structure <br /> <br />Water Lines <br /> First 100 ff, or fraction thereof <br /> <br /> '~ .$ 9.oor~qc° <br />--,$ 9.00 <br /> ..... ~ 4,50 <br /> I $20.00~0°v <br />--$15.00 <br /> { ,s3o,oo~Occ <br /> <br /> For additional 100 fegk(up <br /> <br />COMMERCIAL (each fixture) <br /> <br />New constnactibn ~$ 9.00 __ <br />Alterations ~$ 9.00 ~ <br />Re-located structure __ $ 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 fraction thereof __$30.00 ~ <br />For additional 100 feet __$15.00~ <br /> <br />C, LAWN sPRINKLER, sYSTEM <br /> <br />Each protective backflow device <br /> <br />--$4.50 , <br /> <br />OTHER (as required by OSPSC and <br />Building Officml) <br /> <br /> q <br />Al. Enter total &fees from Sec, # 4 <br />A2. Add 5% SUrcharge (.05 x Al) $ <br /> <br />Subtotal $ <br />Enter 25°/; of line A1 for Plan Review <br /> (,25 x Al) if required ~ $ <br />C. Investigation Fee(if required)//a t i$ .... <br />D. Reinspection Fee ( (~30 <br /> To'r^tA OUNTDU "--/. $ <br /> <br /> <br />