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' 3R OFFICE USE ONLY <br />Received by: <br /> Date: ,,, <br /> <br />MARION COUNTY BUiLDING INSPECTION <br /> <br />PLUMBING PERMIT APPLICATION <br />P/ease complete ail Sections, I through <br /> <br />220 ~ S~eet NE <br />Salem, Oregon 97301 <br /> <br />Phone 588-$147 S:O0mm, ~ 4:30 p.m. <br />C~d~-A-Phone:58S-7904 <br />F,~:588-7948 <br /> <br />94-03881 58661 <br />SITE ~: 94-03868 Perm~No. 58645 <br /> <br />Date: ~qov~mbor ] 8, ] 994 .... <br /> <br />Issued by: <br /> <br /> I. LOCATION OF IN~'TALLA TiON <br /> <br />/ob Ad4re~, 1 _~.8~t h <br /> <br />PEKMITS AP, JZ NON.TRANSFER.AB LE AND NON.P,.~FLTNDABLE AND <br />EXPIRE IF WOKK IS NOT STA~ ~ lB0 DAY~ OF ISSUANCE <br />OK IF WORK IS 8USP~DED PO~ 180 DAYS. <br /> <br /> 2A, CONT~CTOR INSTALLATION ONLY <br /> <br />~.t~t0~ ~ PLyiNG { ~h°"'873-4993 <br />~iliagAdd~ss 1615 Pine, silverton,OR 97381 <br /> <br />P~p~ae, Russell Voeller { Ph~.~370-7802 <br /> <br /> ~B. FOR OWNER INSTA~TIO~ <br /> <br />CitylStat¢/Zip <br /> <br />Th~ jnstallalioa ia being made on propetW I own which is not intended for sale, <br /> <br />3, PLAN REVIEW SE(TI'ION <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 <br />required submission of plans, and specifications when requh-ed <br />by die Oregon Structural Specialty Code, Chapter <br /> <br />4. FEE $CI~DULE (Complete and en~rt total ia Al below) <br /> [] SIDEm'IAL [] COMM .CZ L <br /> OSE OF ~U~: ~ <br /> <br />NO, XFEE =SUM <br /> <br />BASE FEE $20,00 <br />A, iLESIDENTIAL <br /> <br />Single Family or multi-Family per <br />dwelling unit (each fixture) <br />New con~U'uctian ~ $ 9.00 .... <br />Alterations · $ 9.00. <br />Re-located strualure $ 4,50~ <br /> <br />Water Lines <br /> Fin~t 100 fi. or fraction thereof <br /> For additional 100 fi, (up to <br /> maximum orS00 feet) <br /> <br />Sewer Lines <br /> Fi~t 100 feet or fraction thereof <br /> For additional 100 feet (up to <br /> maximum 500 feeo <br /> <br />__$20.00-- <br /> <br />--$15.00 - <br /> <br /> __$15.011 <br /> <br />New constnmti6n <br />Al~mtiom } <br /> <br />Re-located structure <br /> <br />Wa~r Lines <br /> First 100 feet or fraction thereof <br /> For add/tional I00 feet <br /> <br />Sewer LLues <br /> F/mt 100 feet or fraction thereof <br /> For additional 100 feet <br /> <br />LAWN SPRINKLEtL SYSTEM <br />Each protective backflow device <br /> <br />OTHER (as reguired by OSPSC and <br />Building Offietal) <br /> <br />__$ 9.00_ <br /> <br /> ,o0.7 <br /> ,00 <br /> <br />--s 4.sod <br /> <br />$. FEES Al. Elater total of fees from Sec. # 4 <br /> A2, Add 5% surcharge (,05 xA1) <br /> <br /> Subtotal <br />B. Eater 25% of line A1 for Plan Review <br /> (,25 x Al) if re<mired <br /> C, Investigation Fee (if~equlred) <br /> D. Rcinspection Fee <br /> <br /> TOTAL AMOUNT DIJF~ <br /> <br />Receipt No, <br /> <br />$ <br />$ <br />$ <br /> <br /> <br />