Laserfiche WebLink
FOR OFFICE USE ONLY <br />I Received by: <br />[.Date:_ , .......... <br /> <br /> ' 1 <br />Salem, 0~o~ 9730 <br /> <br />PLUMBING PERMIT APPLICATION <br />Please complete all Sections, I through <br /> <br /> .... <br /> <br />Pho~ SgS-~147 S:00 a,m, ~ 4:30 p.m, <br />Code~A-Phoae: 588-7904 <br /> FAX: SgS-794S <br /> <br />SITl~/~/~vu tlVSP~CTION <br />Date: <br /> <br />4. FEE SCI:IEDUI.,E (Complete and eater total in A1 b~low) <br /> m stoE ,rrlar [-q CO VrERa <br /> <br /> NEW L~ALTI~IL~TIoIq ~]ADDIIION [~ REIA~ATION ~ <br /> <br />FERMIT~ ARB NON.TRANSFER.&BLE AN <br />~PI~ IF WO~ IS NOT STAR~ ~ I g~ ~YS OF I~UANCE <br />O~ IF WO~ ~S S~SpEHD~D FOK l~O DAYS. <br /> <br /> ~. CO~CTOR INSTALLATION ONLY <br /> .' ..... <br /> <br />FOR OWNER INSTALLATIONS <br /> <br />Mailing Add~s <br /> <br /> te SeCtio <br />We will provide plan review service if you comple <br /> s and ~pecifi uti ith ' <br />5B and submit two (2) sets of plan c ohs w ,,, <br />this application. <br />This optioaal plan review program does not suspend tho. <br />required submission of plans, and specifications when required! <br />by the Oregon Structural Specialty Code, Chapter 53. <br /> <br />c 13:45 <br />leer. 7192 <br /> <br />BASE FEE <br />A, KESIDENTIAL <br /> Single Family. or multi-Faqxi, 'ly per <br /> dwelling unit (each fixtxxm) <br /> New construction <br /> Alterati6ns ' <br /> Re-located structure <br /> <br /> Water Lines <br /> First I00 IL or fi.action thereof <br /> For additional 100 tt, (up to <br /> maximum of 500 feet) <br /> <br /> Sewer Lines <br /> First 100 feet or fi'action thereof <br /> Fo~ additional 100 feet (up to <br /> maximum 500 feet) <br /> <br />B, COIvlMERCLAL (each fixture) · <br /> <br /> New constmctidn <br /> Almrations <br /> Re4ocated stmctare <br /> <br /> Water Lines <br /> First 100 feet or fi.action thereof <br /> For, additional 100 feet <br /> <br /> Sewer Lines <br /> First 100 feet or fi.action thereof <br /> For additional 100 feet <br /> <br /> C, LAWN SPRINKLER sYSTEM <br /> Each protective backflow device <br /> <br /> D. OTHER. (~as~reeu.!red by OSPSC anti <br /> Building ommal) <br /> <br />NO. XFF-E 'SUM <br /> <br />$20.00 <br /> <br />FEES <br />Al. Enter total of fees from Sec, g 4 <br />Ag. Add J% surcharge 005 x Al) <br /> <br /> Subtotal <br /> ~ter 25% of line A1 for Plm~ Review <br /> (.25 x Al) if required <br />C, Investigation Fe~[ifreq'aired) <br />D. Keius~tioa Fcc <br /> TOTAL AMO~ DUE <br />Receipt No. <br /> <br />9.0oJ~ 60 <br />9,00~ <br />4.50. <br /> <br />$20.0¢ . <br /> <br />__.$15.00: <br /> <br />· $30.00 - <br /> <br />= $t5.o0 - <br /> <br />9,00 <br />9.0o <br />9.00 <br /> <br />¢1520100 11' <br />--.$15.00~ <br /> <br />,$30,00 <br />$15.00 <br /> <br />-$ 4.50~ <br /> <br />3o°.00 <br /> i .'~ o <br /> <br /> <br />