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PLUMBING PERMIT APPLICATION <br />P/ease complete all Sections, 1 through 5 <br /> <br /> Salem, Oregon97301 dan , N't/I/I <br /> ~ '"' <br />~one~S~-5147 8;00~ 4;30p.m, SITE ~:~,~. <br /> ~e-A-~on*: 588-7904 ~t ,. ' ' tt~l~ COt t~, <br /> V~: 588-7948 Date' UILDIN~ <br /> <br /> Issued by: <br /> <br />LOCATION OF INSTALLATION <br /> <br />PERM]TS ARE NON-TRANSFEPJ~BLE AND NON-REFUNDABLE AND <br />EXPIRE IF WORK IS NOT STARTED W/THIN 180 DAYS OF ISSUANCE <br />ORIF WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A, CONTRACTOR INSTALLATION ONLY <br /> <br />Plumbing Boar~; <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br />The installation ia being made ol~ property I own which ia act intended for sale. <br /> <br />Owners Signature <br /> <br /> 3, PI,AN REVIEW SECTION <br /> <br />BASE FEE <br />A. KESIDENTiAL <br /> <br />Single Family Or multi-Family per <br />dwelling unit (each fixture) <br /> New construction <br /> Alterations <br /> Re-located smmture <br /> <br />NO, XFEE =SUM <br /> <br /> $20.00 <br /> <br />9.00 <br />%00 <br />430__ <br /> <br />Water Lines <br />First 100 fi. or fraction thereof --$20.00 <br />For additional 100 ft. (up to <br />maximum of 500 feet) -- $15,00 <br /> <br />Sewer Lines <br />First 100 feet or fi'action thereof --$30.00 <br />For additional 100 feet (up to <br /> maximum 500 feet) __ $15.00 <br /> <br />B. COMMERCIAL (each fixture) <br /> <br />New constructidn <br />Alterations <br />Re-located structure <br /> <br />Water Lines <br /> First 100 feet or fraction thereof <br /> For additional 100 feet <br /> <br />__ $ 9.00 <br />-- $ 9,00 <br />__$ 9,00__ <br /> <br />--$20,00 <br />--$15.00-- <br /> <br />Sewer Lines <br />First lO0 feet or fraction thereof __ $30,00 <br />For additional 100 feet --$15.00-- <br /> <br />C. LAWN SPRINKLER SYSTEM <br /> <br />Each protective backflow device I $ 4.50 ~,~'0 <br /> <br />D, OTHER (as regalred by OSPSC and <br /> Building Official) <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 the <br />required submission of plans, and specifications when ~equired <br />by the Oregon Structural Specialty Code, Chapter <br /> <br />kJC 15.45 <br />Rev, 7/92 <br /> <br />5. FEES <br />Al. Entertotal of fees from Sec. # 4 <br />A2. Add5%surchaxge(.05xA1) $ ,- ~ <br /> <br /> Subtotal $ <br />B, Enter 25% ofllne A1 for Plan Review <br /> (.25 x Al) if required $ <br /> C. investigation Fee (if required) $ <br /> <br /> TOT~L~MMOUNT ~UE $ <br /> Recdpt No. ( ~)3 rT~'- <br /> <br /> <br />