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]FOR OFFIC~fSE ONLY <br />/ffat~:' 6/g I~ SMem, Oregon 97301 <br /> <br /> PLUMBING PERMIT APPLICATION ~: ~38.7~48 Date: <br /> Please complete al/Sections,, through 5 ] ,ssued <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />p~R,MaFI'S ARE NON-TRANSFERABLE AND NON-KEFUNDABLE AND <br />EXPIRE IF WORK I$ NOT STARTED WITHIN 1 S0 DAYS OF ISSUANCE <br />OR IF WORK IS SUSPENDED POP 180 DAYS, <br /> <br /> 2A. CONTRACTOR INSTALLATION ONLY <br /> <br /> ~ I <br />Plumbing Bo~d: <br /> <br />The installation is being made oa ptopeay I ow~ which is not intended for sale, <br /> <br />3. PLAN REVIEW SECTION <br /> <br />4. ~ SCflEDUI,E (Complete and cater total in A1 below) <br /> [~]~ I~SIDENTIAL [~ COMIV~RCIAL <br /> <br /> ~w I~rs~o~ [] Am~o~ ~ ~uo~ ~ <br /> <br /> BASE FEE <br /> A, RESIDENTIAL <br /> <br /> Single Family or multi-Family per <br /> dwelling unit (each fixture) <br /> blew construction <br /> Alterations <br /> Re-located smtcture <br /> <br /> Water Lines <br /> First 100 It, or fraction thereof <br /> For additional 100 It. (rip to <br /> maximum of 500 feet) <br /> <br /> Sewer Lines <br /> First 100 feet or fraction thereof <br /> For additional I00 feet (up to <br /> maximum 500 feet) <br /> <br /> 3. COMMERCIAL (each fixture) <br /> <br /> New constructi6n <br /> Alterations <br /> Redocated st~ructu~ <br /> <br /> Water Lines <br /> First I00 feet or fraction thereof <br /> For additional 100 feet <br /> <br /> Sewer Lines <br /> First 100 feet or fraction thereof <br /> For additional I00 feet <br /> <br />C, LAWN SPRINKLER. SYSTEM <br /> <br /> Each protective backflow device <br /> <br />D. OTHER (as recjuired by OSPSC and <br /> Building Officml) <br /> <br /> NO. XFEE -SUM <br /> <br /> $20.00 <br /> <br /> $ 9.00~'~ <br /> $ 9.0~/--~ <br /> __ $ 4.~g).----~ <br /> <br /> __$ao.oo g~; <br /> <br /> --$15.00 <br /> <br /> __$30.ooJO, <br />__$15.00 <br /> <br /> $ 9.00__ <br /> --$ 9,00 <br /> --.$ 9.00 <br /> <br /> --$20.00-- <br /> --$15,00 <br /> <br />__$30.00__ <br />--$15,00, <br /> <br />--.$ 4,50 <br /> <br />We will provide plan review service if you complete Section <br />5B and 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 Specialty Code, Chapter 53, <br /> <br />¢C/J-4J <br />Rev, 7/92 <br /> <br />5. FEES <br />Al. Enter total offecs from Sec. # 4 <br />A2. Add 5% surcharge (.05 x Al) $ <br /> <br /> Subtotal $ <br />B. Enter 25% of line A1 for Plan Review <br /> 625 x Al) if requked $ <br /> C, Investigation Fec(ifrequfl-ed) $ <br /> D, Reinspection Fee $ <br /> TOTAL AMOtnqT DU~o~ <br /> <br /> <br />