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I __ i MARION COUNTY BUILDING INSPECTION <br />I ]?.OR OFFICE USg- ONLYI <br /> . <br /> <br />[Date:/~ <br /> ~onc 588.5 ~47 <br />PLUMBING PERMIT APPLICATION <br />Please complete all Sections, <br /> <br /> 1, L~ATION OF INSTALLATION <br /> <br />PERMITS ARE NON-TRANSFERABL~ AND NON-REFUNDA~qLE AND <br />EXPIRE IF WORK IS NOT STARTED WITHIN 1 S0 DAYS OF ISSUANCE <br />OR IF WORK Ia SUSI'ENDI~D FOR 180 DAYS, <br /> <br /> 2A, CONTRACTOR INSTALLATION ONLY <br />Conlta¢ior ~ <br />Mailing Address <br /> <br />JPhone <br /> <br />Property Owner ] Phone <br />Plumbing Board: <br /> <br />Contractors <br /> Beam <br /> <br /> 2E. FOR OWNER INSTALLATIONS <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 pi,an review progrmn does not suspend the <br />required submission of plans, and specifications when required <br />by the Oregon Structural Specialty Code, Chapter 53. <br /> <br />~ 15-45 <br /> <br />Rev. 7192 <br /> <br />4, FEE S~IRDULE (Complete and eater total m A1 b~low) <br /> I,/T m~smn~rr~j. [~ COMMERCIAL <br /> <br /> lql~W ~Al,~,nx[o~ [~.tdcot~o~ [] E~oc~r~o~q [] <br /> <br />NO, X FEE = SUM <br /> <br /> $20.00 <br /> <br /> BASE FEE <br /> A, RESIDENTIAL <br /> <br /> dSwing).e Family or multi-Family per <br /> ening unit (each fixture) <br /> New construction --, $ 9.00 <br /> Alterations --, $ 9.00 <br /> Re-located structure --, $ 4,50 <br /> <br /> Water Lines <br /> First 100 1% or fraction thereof <br /> For additional 100 Ii. (up to <br /> maximum ors00 feet) <br /> <br /> Sewer Lines <br /> First 100 feet or fraction thereof -- $30.00 <br /> For additional 100 feet (up to <br /> max/mm 500 feet) __$15.00 <br /> <br /> B. COIvllvlERCIAL (each fixture) <br /> <br /> New constmcti6n __ $ 9.00 <br /> Alterations --$ 9,00 <br /> Re4ocated structure -- $ 9.00 <br /> Water Lines <br /> Fimt 100 feet or fraction thereof -- $20.00 <br /> For additional I00 feet --$15.00 <br /> Sewer Lines <br /> First 100 feet or fraction thereof -- $30,00 <br /> For additional 100 feet --.$t5.00 <br /> <br /> C. LAWlS! SPRINKLER. SYSTEM <br /> Each protective backflow device $ 4.50,,, <br /> <br />D, ~OTHER (as rec. luired by OSPSC and <br /> u~ilding Official) <br /> <br />5, FEES <br />Al. Enter total of fees from Sec. # 4 Z-0. OO <br />A2. Add 5% surcharge (,05 x Al) $ <br /> <br /> Subtotal $ <br />B. Enter 25% &line Al for Plan Review <br /> (,25 xAl) freouired <br /> C, Investigation Fee[if~rc,~uire~ <br /> <br /> TOTAL AMOUNT DUE ' $ <br /> <br /> <br />