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Received by: [~klr <br />Date: L O -[~ - ~ ~I ] <br /> <br />PLUMBING PERMIT APPLICATION <br />Please complete all Sections, 1 through 5 <br /> <br />MARION COIJNTY BUILDING INSPtlI~I~N~ <br /> <br /> 220 High $~reet NE j~ ~ <br /> <br /> Phone 588-5147 8:00 ~.- 4:30 p,m. SITE ~; PermR No, <br /> ~a,-~-~o~: ~ss.~ MARION COUN'I'~ <br /> ..... ~CTION <br /> Issued by: <br /> <br />LOCATION OF INSTALLATION <br /> <br /> '0 ..... "' <br />PERMITS APE NON-TRANSFERABLE AND NON-R.EFLrNDABLE AND <br />EXPIR~ IF WORK IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE <br />OR IF WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR iNSTALLATION ONLy <br />Contractor ] Phone <br />Maili~lS Address <br /> <br />~e installation is being ~e on pwpe~y I o~ whivh is not intended ~r <br /> <br />3, PLAN REVIEW SECTION <br /> <br />We will provide plata 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 subm ission of plans, and specifications when required <br />by lhe Oregon Structural Specialty Code, Chapter 53. <br /> <br />Rev, 7/92 <br /> <br />4. ~ S~C~DULE (Complete and enl~r total in Al below) <br /> [] RESID!~NTIAL [~ , COMIvI~R.CIAL <br /> <br />BASE FEE <br />A. RESIDENTIAL <br /> <br /> Single Family or multi-Family per <br /> dwelr_mg u_nfl (each fixture) <br /> New oonsmtetion <br /> Alterations <br /> Re-located structure <br /> <br /> Water Lines <br /> First 100 ff. or fraction thereof <br /> For additional 100 ti. (up to <br /> maxLmura of $60 feet) <br /> <br /> Sewer Lines <br /> First I00 feet or fraction thereof <br /> For additional 100 feet (up to <br /> maximam 500 feet) <br /> <br />B. COMlvIERCIAL (each fixture) <br /> <br /> New constructi6n <br /> Alterations <br /> Re-located structure <br /> <br /> Water Lines <br /> First 100 feet or fraction thereof <br /> For additional I00 feet <br /> <br /> Sewer Lines <br /> First 100 feet or fraction thereof <br /> For additional 100 feet <br /> <br /> C. LAWN SPRINKLER SYSTEM <br /> <br /> Each protective baekflow device <br /> <br />D. OTHER (as re9 .uired by OSP$C and <br /> Building Officml) <br /> <br />NO. X F~E = SUM <br /> <br /> $20.00 <br /> <br /> ~$ %00 <br /> --$ 9.00 <br /> __$ 4.5O__ <br /> <br /> ~$20.00 <br /> <br /> $15.00 <br /> <br /> $30.00 <br />~$15.00 <br /> <br /> __$ 9,00__ <br /> . $ 9,00 ..... <br /> __$ 9,00 <br /> <br /> --S20.00 <br /> --$15.00, <br /> <br /> ~$30.00,, <br /> $15.00 <br /> <br /> [ $4.soq.s° <br /> <br />5. FEES Al, Enter total of fees from Sec. ii 4 <br /> A2. Add 5% surcharge (,05 x Al) <br /> <br /> Subtotal <br />B, Enter 25% of line Al for Plan Review <br /> <br /> C, (,25 x Al) if required <br /> <br /> TOTAL AMOUNT DUE <br /> <br />$ <br /> <br />$ <br />$ <br /> <br /> <br />