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FOR CITY VALIDATIONI <br />Received by: <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br />COMMUNITY DEVELOPMENT CENTER <br />285 Church St NE · Room 132 <br /> Salem, OR 97301 <br /> <br />24 Hr Inspection Line: 588-7904 <br />Off.we: 588-5147 8:00 a.m. - 4:30p.m. <br />FAX: 588-7948 <br /> <br />PLUMBING PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />1. LOCATION OF R4~I'ALLATION <br /> <br /> PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT <br /> STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />Plumbing Board: <br /> <br />Phone .e~_~ <br /> <br />~ob No. " <br /> <br />Journeyman's Plumbem No. <br /> <br />2B. FOR OWN'HR INSTALLATIONS <br /> <br />Prope~y Owner (plemse prim) <br />Mailing Address I Phone <br />City/State/Zip <br />Owner's Signature: <br />Agent's Signature: <br /> <br />3. PLAN REVIEW SECTION <br /> <br />PERMff NO: <br />Date: <br /> <br />Issued by: <br /> <br />4. FEE SCHEDULE (Complete and enter total in Al below) <br /> <br /> RESWtL~qTIAL ~ COMMt~CIAL <br /> use RUC : <br /> <br /> No. X F~ = Sum <br />BASE FEE $20.00 <br /> <br />RESIDENTIAL (each fLxture) <br /> Aurora Dwelling Plumbing Fee <br /> <br />Single Family or multi-family per <br />dwelling unit ~ $10.00 ,-~, <br />New construction <br /> Alterations $ I0.00 <br /> Reconnect $ 5.00 <br /> Relocated Structure $ 5.00 <br /> Modular Structure $ 5.00 <br /> <br />Water Lines <br />First 100 ft. or fraction thereof $20.00 <br />For ea. addnl' 100 ft. (up to <br />maximum of 500 ft.) $15.00 <br /> <br />Sanitary & Storm Lines <br />First 100 fl. or fraction thereof $30.00 <br />For addnl' 100 fl. (up to <br />maximum of 500 fl.) $15.00 <br /> <br />COMMERCIAL (each fixture) <br /> <br /> New construction $10.00 <br /> Alterations $10.00 <br /> Reconnect $10.00 <br /> <br />Water Lines <br />First 100 ft. or fraction thereof $25.00 <br />FOr ea. addnl' 100 fl. (up to <br />maximum of 500 ft.) $15.00 <br /> <br />Sanitary & Storm Lines <br />First 100 ft. or fraction thereof $30.00 <br />For addnl' 100 ft. (up to <br />maximum of 500 ft.) $15.00 <br /> <br />PROTECTIVE BACKFLOW DEVICE <br />Lawn vacuum breaker (sprinkler system) $ 4.50 <br />All others $10.00 <br /> <br />OTHER (as required by OSPSC <br /> and Buil&'ng Ot~cial) <br /> <br />DWELLING PERMIT LABEL # of Lal~is <br /> <br />N/C <br /> <br />Marion County does not require a plan review. <br />We will provide plan review service if you complete <br />Section 5B and submit two (2) sets of plans and <br />specifications with this application. <br /> <br />MC 15-45 <br />Rev. 12/94 <br /> <br />5. FEES <br />Al. Enter total of fees from Sec.//4 $.~ <br />A2. Add 5% surcharge (.05 x Al) $.~ <br /> Subtotal $.~ <br /> <br /> B. Enter 25% of line A1 for Plan Review <br /> (A 1 + .25), if required $.~ <br /> C. Investigation Fee (if required) $ <br /> D. Reinap¢ction Fee ($25.00) $ <br /> <br /> TOTAL AMOUNT DUE $~ <br /> Receipt No. <br /> <br /> <br />