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MARION COUNTY BUILDING INSPECTION <br /> <br /> 220 High Street NE <br /> Salem, Oregon 97301 <br /> <br />Phone 588-5147 $:00 a.m. ~ 4:30 p.m, <br /> FAX: <br /> <br />SITE #: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />Permit No, <br /> <br />1. LOCATION OF INs'rALLATION <br /> <br />Directions <br /> <br />I <br /> <br />PERMITS ARE NON.TP. ANSFERAB LE AND NON.REI:IJNDABLE AND <br />EXPI P~E IF WOl~2 IS NOT STA~II~D WITHIN 180 DAYS OF ISSUANCE <br />OR IF WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A, CONTRACTOR INSTALLATION ONLY <br /> <br />Coatraao, Oudson!..s, Inc ..... } ehe"c~363_41 zl~__ <br />MailingAdd~ss P.O. BOX 12669 Salem, OR 97309 <br /> 7 7;d <br />Plumblng Etmrd: 24-22PB <br /> <br />property Owner <br /> <br />Mailing Address <br /> <br />City/Stalely <br /> <br />The Installation 1~ bcl,8 mad~ on properly I own which is not inl~ndcd for sale, <br /> <br />PI,AN REVIEW SECTION <br /> <br />We will provide plan review service if you complete Section <br />5B und submit two (2) sets of plans and specifications with <br />this application. <br /> <br />This optional platt review program does not suspend llte <br />required submission of pla~s, m'td opecifications when required <br />Dy the Oregon Structural Specialty Code, Chapter 53, <br /> <br />itc 15.45 <br />Rev, 7/92 <br /> <br />4. FEE SCHEDULE (Complete and enter total fa Al below) <br /> ~ESIDENTIAL [] COMMERCIAL <br /> <br /> NEW [] ^L'II~RATION ~X~l'JtllOlq ~ RELOCA'HON [] <br /> <br />BASE FEE <br />A. RESIDI.{NTIAL <br /> <br /> Single Family or multi-Family per <br /> dw6lling unit (each fixture) <br /> New construction <br /> Alterations <br /> Re-located slruclure <br /> <br /> Waler l.ines <br /> First I00 fl. or fraction {hereof <br /> For additional RIO It, (up lo <br /> maximum 0£ 500 feet) <br /> <br /> Sewer Lines <br /> Firsl 100 feet or fraction Ihereof <br /> For a. dditional 100 feet (up tn <br /> maximum 500 Feet) <br /> <br />B, COMMERCIAL(each fixture) <br /> <br /> New cunslructiun <br /> Alteradons <br /> Re-localed $1ructure <br /> <br /> Water Lines <br /> First 100 feet or fraclion thereof <br /> For addiliunal 100 feet <br /> <br /> Sewer Lines <br /> First 100 reel or fraction thereof <br /> For additional 100 feet <br /> <br />C. [,AWl'/SPRINKLER SY'KI~M <br /> <br /> Each prolective backflow device <br /> <br />D. OTIIER (as required by OSPSC and <br /> Lluilding Official) <br /> <br /> $20.00 <br /> <br />__,$ 4.50 <br />___$20.00 <br /> <br />__$15.00 <br /> <br /> __$ 9,00 <br /> <br /> ..... $ 9.00__,__ <br /> <br /> --$20.00 ..... <br /> <br /> ___,$30,00, <br /> __,$15,00 <br /> <br />-- $ 4.50 ...... <br /> <br />5, FEES <br /> <br />Al. Enter total 0frees Rom Sec. # 4 <br />A2. Add 5% surcharge (,05 x Al) <br /> <br /> Subtotal <br />Enter 25% orline Al rot Plan Review <br /> (,25 x Al) if required <br />C. lnvestigatien Fee{if required) <br />D, Rciuspection Pee <br /> <br /> TOTAL AMOUNT DUE <br /> <br />$ <br />$ <br />$ <br /> <br />$ <br /> <br />Receipt No,, <br /> <br /> <br />