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FOR CITY VALIDATION[ <br />Received by:, <br />Date: <br /> <br />MARION COUNTY' BUILDR~G ~NSPRCTION <br /> <br /> 285 Church St NE' Room 132 PERI~F~ <br /> Date:---- <br /> Salem, OR 97301 <br /> <br /> ~ Hr In~a L~e: 5~ MARION COUNTY <br /> F~: 58~7948 <br /> <br />IPLUMBING PERMIT APPLICATION <br />Please complete all Sections, I through <br /> <br />1o LOCATION OF INSTALLATION <br /> <br /> PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT <br /> STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPE. NDED FOR 180 DAYS. <br /> <br />2A. COHTRACTOR INSTALLATION ONLY <br /> <br />Contractor I Phone <br />Mailing Addre~ <br /> <br />Plumbing Board: <br />Contractor's Board Reg. No. Job No. <br />Journeyman's Plumbers No. ~ <br />Contractor's Signature: <br /> <br />2B. FOR OWNIiR INSTALLATIONS <br /> <br />3. PLANRBVIBW SBCTION <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 />F~v. s/gs <br /> <br />4. FBB SCHHDULB (Complete and enter to,al in Al below) <br /> <br /> RraSIDHNTIAL C3 COMMHRCIAL ~ <br /> USt] OF STRUCTURe: /~L L/~ <br /> NEW C] ALTERATION Q ADDrnON Q RELOCATION <br /> <br /> No. X F~ = Sum <br />BASE FEE $2O.00 <br /> <br />RESIDENTIAL (each fixture) <br /> Aurora Dwelhng Plumbing Fee <br /> <br />Single Family or multi-family per <br />dwelling unit <br /> New construction <br /> Alterations <br /> Reconnect <br /> Relocated Structure <br /> Modular Slructure <br /> <br />Water Lines <br /> First 100 fl. or fraction Ihereof <br /> For ea. addul' 100 fL (up to <br /> maximum of 500 ft.) <br /> <br />Sanitary & Storm Lines <br /> First 100 ft. or fraction thereof <br /> For addui' 100 fi. (up to <br /> maximum orS00 fl.) <br /> <br />COMMERCIAL (each fLxture) <br /> <br /> New construction <br /> Alterations <br /> Reconnect <br /> <br />__ sq. ft. x $.065 = ~ <br /> <br />$10.00 <br />$10.00 <br />$5.00 <br />$5.OO <br />$5°OO <br /> <br />$15.00 __ <br /> <br />$~0.00 __ <br /> <br />$15.00 __ <br /> <br />s~o.00 ZoO <br />$10.00 <br />$10.00 <br /> <br />Water Lines <br /> Fu'at 100 ft. or fraction thereof <br /> For ea. addni' 100 fl. <br /> Z $~.00 3 o <br /> <br />Sanitary & Storm Lines <br /> First 100 ft. or fraction thereof <br /> For addnl' 100 fl. <br /> <br />PROTECTIVE BACKFLOW DEVICE <br /> Lawn vacuum breaker (sprinkler system) <br /> Ali otbera <br /> <br />OTHER (as required by OSPSC <br />aad Builch'~g Ol~cial) <br />DWEI.,LIHG PERMIT LABEL //of Labels <br /> <br />$15.00 /,~' <br />S4.50 ~_.~ <br />$10.00 <br /> <br />N/C <br /> <br />5. FBBS <br />Al. Enter total of feea from S~c. fi4 <br />A2. Add 5% surcharge (.05 x Al) <br /> Subtc~al <br /> <br /> B. Enter25% of line Al for Plan Review <br /> (Al + .25), if required <br /> C. Inv~tigation Fee (if required) <br /> D. Reimpection Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br /> Receipt No. <br /> <br />$ <br />$ <br />$ <br /> <br /> <br />