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FOR CITY VALIDATIONI <br />Rocoivmt 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 373-4427 <br />Office: Phone 588-5147 8:005m - 4:30pm <br />FAX: 588~7948 <br /> <br />PLUMBING PERMIT APPLICATION <br />Please complete all Sections, I through <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />Deaefiption/Direefiom: <br /> <br /> PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT <br /> STARTED WITHIN 180 DAYS OF ISSUANCE ORIF <br /> WORK I$ SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />Plumbing Board: <br /> <br />2B. FOR OWNItR INSTALLATIONS <br /> <br />Property Owner (please print) <br /> <br />Mailing Address I Phone <br /> <br />City/State/Zip <br /> <br />Owner's Signature: <br /> <br />Agent's Signature: <br /> <br />3. PLANRBVIEW SECTION <br /> <br />PERMIT NO: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />4. FEE SCHEDULE (Complete and enter total in A1 below) <br /> <br /> RESIDENTIAL ~] COMMERCIAL ~ <br /> USE OF STRUCTURE: <br /> NEW ~l ALTERATION ~1 ADDITION ~1 RELOCATION <br /> <br /> No. X Fe~ = Sum <br />BASE FEE $20.00 <br /> <br />RESIDENTIAL (each fixture) <br /> Aurora Dwelling Plumbing Fee <br /> <br />__sq. ft. x $.070 = <br /> <br />Single Family or multi-family per <br />dwelling unit <br />New construction $10.00 <br />Alterations $10.00 <br />Reconnect $ 5.00 <br />Relocated Structure $ 5.00 <br />Modular Structure $ 5.00 <br /> <br />Water Lines <br /> Firat 100 fl. or fraction thereof <br /> For ea. addnl' I00 fi. (up to <br /> maximum of 500 <br /> <br />Sanitary & Storm Lines <br /> First 100 fl. or fraction thereof <br /> For addnl' 100 fl. (up to <br /> maximum of 500 ft.) <br /> <br />COMMERCIAL (each fLxture) <br /> <br /> New construction <br /> Alterations <br /> Reconnect <br /> <br />Water Lines <br /> First 100 ft. or fraction thereof <br /> For ea. addnl' 100 fl. <br /> <br />Sanitary & Storm Lines <br /> Firat 100 ft. or fraction thereof <br /> For ad&al' 100 ft. <br /> <br />PROTECTIVE BACK.FLOW DEVICE <br /> Lawn vacuum breaker (sprinkler system)__ <br /> Ail others <br /> <br />OTHER (as required by OSPSC <br /> and Building Ot~cial) <br /> <br />DWELLING PERMIT LABEL # of Labels <br /> <br />$20.00 <br /> <br />$15.00 <br /> <br />$30.00 <br /> <br />$15.00 <br /> <br />$10.00 <br />$10.00 <br />$10.00 <br /> <br />$25.oo <br /> <br />$1~.oo <br /> <br />SaO.OO <br /> <br />$15.00 <br /> <br />$4.50 <br />$10.00 <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. 1/96 <br /> <br />5. FEES <br /> Al. Enter total of fees from S~.//4 <br /> A2. Add 5% surcharge (.05 x Al) <br /> Subtotal <br /> <br /> B. Eater 25% of line A1 for Plan Review <br /> (Al + .25), if required <br /> C. Investigation Fee (if required) <br /> D. Reinspection Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUB <br /> Receipt No. <br /> <br /> <br />