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LFOR OFFICE USE ONLY] <br />]Rece ved by-~' <br /> <br /> PLUMBING PERMIT APPLICATION <br /> PI~a~e ¢ornpl~ts all 8eetions, ~ though <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br /> 220 High Street NE <br /> Salem, Oregon 97301 <br /> <br /> Phone 558-5147 $:00 a,m.-4:30p.m. <br /> Code. A-]~hon¢: 5SS-7904 <br /> F~X: 5SS-7948 <br /> <br />Directions <br /> <br />SITE #: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />4. FEE SCItEDIFLE (Complete and ~ total in A1 below) <br /> <br /> USE OF S~U~: <br /> ~W ~L~A~ON <br /> <br />~ERMITS ARE NON-TRANSFERABLE AND NON-1LEFUNDABLE AND <br />F~XPIkE IF WORK IS NOT STAR.TED WITI tIN lSO DAYS OF ISSUANCE <br />OR iF WORK IS SUSPENDED FOR 180 DAYS, <br /> <br />2A. CONTRAL'TOR INSTALLATION ONLY <br /> <br />Maili.g Address Phone <br />CityPStato/Zip <br /> <br />The installation is being made on property I own whleh is not intended for sal~) <br /> <br />Owners Signature <br /> <br />3, PLAN REVIEW SECTION <br /> <br />BASE ~EE <br />A. RESIDENTIAL <br /> <br />NO. XFEE =SUM <br /> <br /> $20.00 <br /> <br />.--.$ 9,00 <br />--.$ 9.00 <br />__.$ 4.50 <br /> <br /> Single Family Or multi-Family per <br /> dwelling unit (each fixture) <br /> New construction <br /> Alterations <br /> Reqocated structure <br /> <br /> Water Lines <br /> First 100 ft. Or fi.action ~emof <br /> For additional 100 i~, (up to <br /> maximum of 500 feet) <br /> <br /> Sewer Lines <br /> First 100 feet ox fraction thereof <br /> For additional 100 feet (up to <br /> maximum 500 feet) <br />B. COMMERCIAL (each fixture) <br /> New cons~'ucti0n <br /> Alterations <br /> Re-located structurc <br /> <br /> Water Lines <br /> First 100 feet or fi.action thereof <br /> For additi0r/al 100 feet <br /> <br /> Sewer Lines <br /> First 100 feet Or fi'action thereof <br /> For additional 100 feet <br /> <br />C. LAWN SPRINKLER SYSTEM <br /> <br /> Each protective baekflow device <br /> <br />D, O'DtER (as required by OSPSC and <br /> Building Official) <br /> <br />__.$20.00 ~. <br /> <br />--~$15.00 <br /> <br />__.$15,00 <br /> <br />__.$ 9.00, <br />--$ 9.00.., <br />__.$ 9.00~ <br /> <br /> / ~;20.00~'c~ <br />--$15.00 <br /> <br />--$30,00 <br />__$15.00 <br /> <br />-- $ 4.50 <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 submission of plans, and specifications when required <br />by the Oregon Structural Specialty Code, Chapter 53. <br /> <br />klC 15:45 <br /> <br />Rev. 7192 <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 Plan Review <br /> (,25 x Al) if required <br /> C. Investigation Fee (i~,requircd) <br /> <br /> TOTAL AMOUNT DUE <br /> <br /> <br />