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/ <br />FOR OFFICE USE ONLY] <br />Recelvcd by: <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTIoN?i~~ <br /> ~20 High ~lxeet <br /> Salem, Oregon 97301 <br /> <br />!}.5',: 2 7 ]993 <br /> <br /> Phone 585.5 t47 $:;00 a,m ~ 4::30 pm SITE#: M A R I1-1 B*~I~,~. i? <br /> Code=A-Phone: 5~8-7904 <br />PLUMBING PERMIT APPLICATION ] ~:~4~ Date: BUILDING INSPECTION <br /> <br /> 1, L~ATION OF INSTALLATION ~ ~ ~ ~E ~D~E (Complete ~d ~t~x to~l ~ A1 ~low) <br /> <br />City <br /> <br />Di~¢tioas <br /> <br />PERMITS ARE NON.TRANSFERABLE AND NON-REFUNDABLE AND <br />EXPIKE IF WORK IS NOT s [ARTED V~JTHIN I SO DAYS OF ISSUANCE <br />OR IF woRK IS SUSPJ~'NDED FOR l SO DAYS <br /> <br /> 2A. CONTRACTOR INSTALI,ATION ONLY <br /> <br />Ma~l}ng Add.ss ~ ~ <br /> T <br /> <br />PlomNng Board ~ ~-/~ <br /> <br />1'~¢ installatioa is being mad~ on p~opetly I ov.n which is not intended for sale~ <br /> <br />Ow net's Signature <br /> <br /> PLAN REVIEW S£CTION <br /> <br />We wi pr~d~[g pl~, rev,ew serv ce if you comp ere Section <br />SB mid submit two (2) sets &plans and specifications with <br />this application <br /> <br />This optional plan review program does not suspend the <br />required submission of plans, and specifications when required <br />by the Oregon Structural Specmlty Code, Chapter 53 <br /> <br />USE OF STgUaTtn~; [] <br /> <br />},mw I'~aLT~j~T~O~ [] aDr~moN [] ~LOCaTION [] <br /> <br /> BASE FEE <br /> A RESIDENTIAL <br /> <br /> Single Family or multi-Family per <br /> dwelling unit (each fixture) <br /> New construction --$ 900~ <br /> Alterations --$ 900-- <br /> Re-located structure __ $ 4.50 <br /> <br /> Water Lines <br /> First 100 R or fraction thereof --$2000 <br /> For additional 100 t%. (up to <br /> maximum o f $ 00 feet) __ $15.00 <br /> <br /> Sewer Lines <br /> Fkst 100 feet or fraction thereof / $30 00~ <br /> For additional 100 feet (ap to <br /> maximum 500 feet) __$1500 <br /> <br />B. COMMERCIAL (each fixture) <br /> <br /> New constmcti6n __ $ 900 <br /> Alterations --$ 900 <br /> Re-located stmcinre --$ 9 0o <br /> <br /> Waler Lines <br /> First 100 feet or fraction thereof / / $2000 <br /> For additional 100 f~¢t -$1500 <br /> <br /> Sewer Lines <br /> First 100 feet Or kaction~hereof __$3OOO <br /> For additional 100 feet __ $15 00 <br /> <br /> C LAWN SPRINKLER SYSTEM <br /> Each protective backflow device --$ 450 <br /> <br />D. OTHER (as reqmmd by OSPSC and <br /> Binlding Official) <br /> <br />NO,, XEklg - UM <br /> <br />FEES <br />A1 Enter total of fees from Sec # 4 <br />A2 Add 5% surcharge (,05 x Al) <br /> <br /> Subtotal <br />rllter 25% of lineAl for P/an Review <br /> (.25 x Al) if required <br />C Investigation FeeO f required) <br />D, geinspection Fee <br /> <br /> [OTAL AMOUNT DUE <br /> <br />¢iC ]5-45 Receipt No, <br />Rev 7~92 <br /> <br /> <br />