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I Receive~l by:__ <br /> <br />PLUMBING PERMIT APPLICATION <br />Please complete all Sections, 1 through 5 <br /> <br /> 1. LOCATION OF INSTALLATION <br /> <br />Job Adar*ss 110-180 10th <br /> 105-185 9th <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br /> 220 High Street NE <br /> Salem, Oregon 97301 <br /> <br /> Phone 588-5147 8:00 a.m, ~ 4:30 p,m, <br /> <br />94-03881 58661 <br />SITE #: 94-03868 Porm~No. 58645 <br /> <br />Date: November 1 R, 1 qq4 <br />Issued by: <br /> <br />PEILMITS AR~ NON-TP, ANSI~RABLE AND NON-REFUNDABLB AND <br />EXPIP.~ iF WoRJ~ I$ NOT STARTED WITHIN 180 DAYS OF ISSUANCE <br />OR IF WORK IS SUSPENDI~D FOR 180 DAYS, <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />Coatra~tot BC ,,PLUI~B~NO I Ph°"'8,~374993 <br />MailingAddrcsa 1615 Pine, silverton,OR 97381 <br /> <br />Ptope~lyOwner Russell Voeller ] Pho.¢370-7802 <br /> <br />C°In~aet°da B°ard ReS' N°'/4~ / ~ 2~ [ I ob No, <br /> <br />FOR OWNER INSTALLATIONS <br /> <br />Property Owncr <br />Mailing Address [ Phone <br />City~State/Zip <br /> <br />Thc inslallation is b¢iaS made on property I own which is not intended for ~ale, <br /> <br />Owner's Signa:ut~ <br /> <br /> 3. PLAN REVIEW SECTION <br /> <br />We will provide plan review service if you complete Section <br />SB aJxd 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 />Rev, 7/92 <br /> <br />4. FEE SCIIEDULE (Complete and enter total in Al below) <br /> [] m~SID~NTIAL [] COMMERCIAL <br /> USE OF STRU~: [] <br /> NBW [] ALTERAI/ON [] ADDrlION [] ILeUOCAIION [~ <br /> <br />NO, XPEI~ =SUM <br /> <br />BASE FEE $20.00 <br />A. RESIDENTIAL <br /> <br /> Single Family or multi-Family per <br /> dwelling unit (each fixture) <br /> New construction --.$ 9,00- <br /> Alterations --$ 9.00 <br /> Re-located structure __ $ 4,50., <br /> <br /> Water Lines <br /> First I00 fr. or fraction thereof __$20.00. ........ <br /> For additional 100 fr. (up to <br /> maximum of 500 feet) -- $15,00 <br /> <br /> Sewer Lines <br /> First 100 feet or fraction thereof -- $30,00 ........ <br /> For additional 100 feet (up to <br /> maximum 500 feet) -- $15,0IL ....... <br /> <br /> B. COMMERCIAL (each fixture) <br /> <br /> Re-located structure ,.~> ~$ 9~00 <br /> Wat~ksL~ll~0 feet o~fthereof~"~ ,,O '$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 --. $15,00 <br /> <br /> C. LAWN SPRINKLER SYSTEM <br /> Each protective backflow device --. $ 4.50 <br /> <br />D. OTIIEK (as reguired by OSPSC and <br /> Building Official) <br /> <br />$, FEES <br /> Al, Enter total of fees from Sec, # 4 <br /> ,4,2, Add 5% surcharge (.05 x Al) <br /> <br /> Subtotal <br />B. Enter :'5% of line A1 for Plan Review <br /> (.25 x Al) if require4 <br /> C, Investigation Fee (i f required) <br /> D, I{einspection Fee <br /> <br /> TOTAL AMOUi'TI' DUE <br /> <br /> Receipt No. ,,, <br /> <br />$ <br /> <br />$ <br /> <br />$ <br />$ <br />$ <br /> <br />$ <br /> <br /> <br />