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[FOR OFFICE USE <br /> la,,I <br /> <br /> PLUMBING PERMIT APPLICATION <br /> Please complete all Sections, I through 5 <br /> <br />1. LOCATION OF 1NS~ALIATION <br /> <br />C~oss St. /~ ~'/~ <br /> <br />OKIF WOKg. IS SUgPENDED FOR lS0 DAYS, <br /> <br /> 2A, CONTRACTOR INSTALLATION ONLY <br /> <br />pERMITS APE NON-T]g,ANS£ERABLE AND NON-~DABL~ AND <br />EXPIRE IF WORK I$ NOT STARTED WITHIN 180 DAYS OF ISSUANCE ' <br /> <br />Mailing Address <br /> <br />Property Owner <br /> <br />Plumbing 8oaYd: <br /> <br />Contractogs Board Reg. No, <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COM~JNITY DEVELOPMENT CENTER <br /> <br />2g$ Chx~h St, NE - Room 132 <br />Salem, Oregon 97301 <br /> <br />No. <br /> <br /> 2B. FOR OWNER INSTALLATIONS <br /> <br />'~e ins~llatioa b beln8 rome an pwpefly I own which is not intended for ~le, <br /> <br /> 3. PLAN REVIEW SE~ION v~[ <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 required <br />by the Oregon Structuzal Specialty Code, Chapter 53, <br /> <br />MC 15-45 <br />Rev. 8/94 <br /> <br />Phone S$8.5147 S~O0 a,m, - 4:30 p.m, <br />Cod~-A-Phoae: S$$-7904 <br /> FAX: 588-7948 <br /> <br />I <br /> <br />SITE#: <br /> <br />Date: <br /> <br />IssueODy: <br /> <br />4. FEE S~.~EDLrLE (Complete and enter total in A1 b~low) <br /> [] RESIDENTIAL [~ COMMERCIAL <br /> U~I~ (Y~ S'IRUC'i~P~E: ~ <br /> ~w ~o~ ~ ~ot'ao~ ~no~ ~ <br /> <br />NO, X FEE - SUM <br /> <br /> $20.00 <br /> <br /> BASE FEE <br /> A. RESIDENTIAL <br /> <br /> Single Favaily or multi-Family per <br /> dwelling unit (each fixtuze) <br /> New consiruction --$ 9.00--.. <br /> Alterations $ 9,00-- <br /> P,_e4oca~ed $w.~ctm~e __$ 4,50 <br /> <br /> Water Lines <br /> First I00 fi, or fraction thereof $20.00 <br /> For additional 100 ff. (up to <br /> maxiraum orS00 feet) $15.00,, <br /> <br /> Sewer Lines <br /> Fkst 100 feet or fraction thereof __ $30.00~ <br /> For add/tional 100 feet (up to <br /> max/raum 500 feet) <br /> <br />B. COMMERCIAL (each fixture) <br /> <br /> New constructi6n __ $ 9.00 <br /> AR~raticm$ --$ 9.00 <br /> Re-located structure $ 9,00 __ <br /> <br /> Water Lines <br /> First 100 feet or fraction thereof <br /> For additional 100 feet <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 d, evice t $ 4.50~ <br />D. OTHER (as ~e§uired by OSPSC and <br /> Building Official) <br /> <br />--$20.00,, <br />--$15,00--. <br /> <br /> Al. Enter total &fees from Sec. # 4 <br /> A2. Add 5% su~cb~ge (.05 x A1 ) <br /> <br /> Subtotal <br />B. Ent~ 25% of line A1 for PI~ Review <br /> (.25 X Al) if required <br /> C. Investigation Fee [i~ required) <br /> <br /> TOTAL ~OUm DUE <br /> <br /> <br />