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FOR OFFICE USE,ONLYI <br /> <br />PI_UMBING PERMIT APPLICATION <br />Please complete all Sections, 1 through 5 <br /> <br />220 High Stxeet NE ~[~1~' ' <br />Salem, Oxegon 97301 -- OCT 0 <br />P~uc 588-5147 8:00 a.m. ~ 4:30 p,m, <br /> <br /> F~: 588-7948 D~III m~,~ .... <br /> Issued <br /> <br /> 1, LOCATION OF INSTALLATION <br /> <br />~PI~ IF WO~ IS NOT STAR~ ~THIN 180 DAYS OF ISSUANC~ <br />OR IF WO~ IS SUS~NDED FOR 180 DAYS, <br /> <br />2A, CONTRACTOR INSTALLATION ONLY <br /> <br />PmpcAyOwner [,,Phone <br /> <br />Plumbing Board: <br /> <br />Contractor's Signature: <br /> <br />2B, FOR OWNER INSTALLATIONS <br /> <br />3. PLAN REVIEW SECTION <br /> <br />We will provide plan review service if you complete Section <br />5B mid 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 />;~.:15.4b <br /> <br />Rev. 7/92 <br /> <br />4. F~E SCItEDUL~ (Complete and ~t~z~lotal in A1 below) <br /> ~ RESIDENTIAL ~" COIVlIvIERCIAL <br /> USE OF STRUCtURe: ~ ON <br /> <br />BASE ~FEE <br />A. P,~SIDENTIAL <br /> <br />Single Family or multi-Family per <br />dwelling anit (each fixture) <br /> New consmaction <br /> Alterations <br /> Re-located structure <br /> <br />NO. XFEE -SUN/ <br /> <br /> $20.00 <br /> <br />--$ 9.00 <br />--.$ 9,00 <br />__.$430 <br /> <br />Water Lines <br />First 100 fi. or fi.action thereof __$20.00 <br />For additional 100 R. (up to <br />maximum of 500 feet) --. gl 5.00 <br /> <br />Sewer Lines <br />First 100 feet Or fraction tlmreof --.$30.00 <br />For additional 100 feet (up to <br /> maximum 500 feeo ~$15,00 ,, <br /> <br />B. COMMERCIAL (each fixture) <br /> <br />New comtructi6n <br />Alterations <br />Re-located structure <br /> <br />__.$ 9,00~ <br />--$ 9.00~ <br />__ $ 9.00~ <br /> <br />Water Lines <br />First 100 feet or fraction 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 __. $ I 5.00- <br /> <br />C, LAWN SPRiNICLER SYSTEM <br /> <br />Each protective backflow device <br /> <br />D, OTHER (as regudred by OSPSC and <br /> Building Official) <br /> <br />,, [ <br /> <br />I5. FEES ~ <br /> Al. Enter total of fees from Sec. g 4 <br /> A2. Add 5% surcharge 605 xA1) $ <br /> Subtotal $ <br /> <br />13, Enter 25% of line A1 for Plan Review <br /> (.25 x Al) if required <br /> C. Investigation Fee ~.f. rprqdircd)) ~ <br /> D. Rc~nobccti.~, PLr~ Cd. ~ $ I O, ~ <br /> TOTAL AMOLrNT DUE" $ ~."~ <br /> <br /> <br />