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Received by: ' .,d2,~R-~' <br />I .... ~ ~ I <br /> <br />PLUMBING ~'ER~rr APPLICATION <br />Please complete all Sections, 7 through 5 <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br /> 220 High Street NE <br /> Salem, Oregon 97301 <br /> <br /> ]?bone 588-5147 $:00 a,m. ~ 4;30 p,m. <br /> Code.A-Phone: 5~8-7904 <br /> FAX: 588-7948 <br /> <br />1, LOCATION OF 1N~£ALLATION <br /> <br /> # <br /> <br />Diroctlons <br /> <br />PEI{M1TS ARE NON-TRANSFEIIABLE AND NON-P,~FUNDABLB AND <br />EXP~P,E IP WO~ I5 NOT BTA~D ~{~ 1~0 DAYS OF ISSUANC~ <br />OR I~ WO~ ~S ~USP~NDED FO~ 180 DAY~, <br /> <br /> ~A, CONT~CTOR INSTALLATION ONLY <br /> <br />Mailit~g Address <br /> <br /> FOR OWNER INSTALLATIONS <br /> <br />itls~llation is being ~c on gmpe~y ] own ~ich is not invaded for sale, <br /> <br />We will provide plan review service if you complete SectiOn <br />5B and submit two (2) $ets of plans and specifications with <br />this application. <br /> <br />This optional plan review program does not suspend the <br />required submissioa of plans, a~d specifications when reqlired <br />by the Oregon Structural Specialty Code, Chapter 53. <br /> <br />~C 15-45 <br />Rev. 7/92 <br /> <br />SITE #: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />Permit No. <br /> <br />BASE FEE $20.00 <br />A. RESIDEIq'HAL <br /> <br /> Single Family or multi-Family per <br /> dwelling unit (each fixture) <br /> New constxuction --.$ %00 -, <br /> Alterations $ 9.00 -- <br /> Re4ocatod structure __$ 4.50. <br /> <br /> Water Lines <br /> First 100 l'c, or fraction thereof --,$20.00 <br /> For additional 100 fc (up to <br /> max/mm of 500 feet) $15.00-- <br /> <br /> Sower Lines <br /> Fixst 100 feet or fraction thereof __.$30.00 <br /> For additional 100 feet (up to <br /> maximum 500 feet) ~ $15,00 . <br /> <br />B, COMMERCIAL (each fixture) <br /> New constmcti6n ~ $ 9.00.~ff~_~ <br /> Alterations -- $ 9.00~ <br /> Re-located structure __ $ 9.00~,__ <br /> <br /> Water Lines <br /> First 100 feet or fraction thereof ,--~--/$20,00 ~' <br /> Foradd/tional 100 feet - -1;15.00- <br /> <br /> Sewer Lines <br /> First I00 feet or fraction thereof ~ $30,00~~ <br /> For additional 100 feet ~ $15. <br /> <br /> C. LAV~N SPRINKLEKSYSTEM <br /> Each protective backflow device ~, $ 4.50 -- <br /> <br />D. OTHER (as reclulred by OSPSC and <br /> Building Official) <br /> <br />5. FEES Al, F~ntor total of fees from Sec. # 4 <br /> A2, Add 5% surcharge (,05 x Al) <br /> ~4~ 7-~?-.-~ Subtotal <br />~, ~,,,~'~%~%~flh~ Ai ~r ~l~vi~' <br /> 625 x Al) J[required <br /> C, Investigation Yce~irreqUlred) <br /> D, Reins~ction F~ <br /> <br /> TOTAL AM0~ DUE <br /> <br />$ <br />$ <br /> <br /> <br />