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/Reeeived by: - ! Yq=y=n. I <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> SITE #; <br /> <br />220 High Street NE <br />Salem, Oregon 97301 <br /> <br />Phone 585-5147 8:00 *-m. - 4:30 p.m. <br />Cod~-A-Flmne: 588-7904 <br /> FAX: 588.7948 <br /> <br />IPLUMBING PERMIT APPLICATION <br /> Please complete all Sections, I through 5 <br /> <br />Date: MARIfiN COUNTY <br />~ssue~D. tNG INSPECTION <br /> <br /> LOCATION OF INSTALLATIOn,,. <br /> <br />,o Add.,, <br /> <br /> I~ <br /> <br /> ' <br />P~ A~ NON-~N~B~ AND NON-~DABLg AND <br />~PI~ IF WO~ IS NOT STAR~ ~ 180 DAYS OF I$$UAN~ <br />OR IF WO~ IS SUSP~DED FOK 180 DAYS, <br /> <br />2A~ CONTRACTOR INSTALLATION ONLY <br />Cintractor <br /> <br />Mailins Address <br /> <br />' L <br />PWpe~ty Owtler Phone <br /> <br />Co~traoto f s Board RcS, No, [ lobNo. <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br />3.~AN R~VIEW SECTION V <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 optional plan review program does not suspend the <br />required s6bmission of plans, and specifications when required <br />by the Oregon Structural Specialty Code, Chapter 53. <br /> <br />[CT5-45 <br />Rev. 2/92 <br /> <br />4. FEE S~[-~E (Complete and ¢ntar total in Al below) <br /> [] [] CO ZaA <br /> <br /> ~w []*t~o~ [] mOmON 5~' moc~ [] <br /> <br />NO. X FEE = SUM <br /> <br /> $20.00 <br /> <br />BASE FEE <br />A. RESIDENTIAL <br /> <br /> Single Family or multi-Family per <br /> dwelling unit (each fixture) <br /> New construction ~ $ 9.00~,~, <br /> Alterations ~ $ 9,00 ~-u~ <br /> Re-located sWucture __$ 4,50 <br /> <br /> Water Lines <br /> First 100 R. or fraction thereof __$20.00----- <br /> For additional 100 ii, (up to <br /> maximum of 500 feet) -- $15,00 <br /> <br /> Sewer Lines <br /> First 100 fee~ or fraction thereof __$30.00 , ,, <br /> For additional 100 feet (up to <br /> maximum 500 fee0 __,$15.00.~ <br /> <br />B. COMMERCIAL (each fixture) <br /> <br /> New construction __$ 9,00__ <br /> Alterations --$ 9.00 <br /> Re4ocated structure __$ 9.00__ <br /> <br /> Water Lines <br /> First 100 feet or fraetian 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 __$15,00 <br /> <br /> C. LAWN SPRINKLER SYSTEIVI <br /> Each protective backflow device --$ 4.50 <br /> <br />D. OTHER (as re[luired by OSPSC and <br /> Building Offieml) <br /> <br />5. FEES Al. Enter total of fees from Sec. # 4 <br /> A2. Add 5% surcharge (.05 x Al) <br /> <br /> Subtotal <br />B. Enter 25% of line A1 for Eau Review <br /> (.25 x Al) if required <br /> C, Investigation Fee (ifrcqu/red) <br /> <br /> Regeipt No. <br /> <br /> <br />