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MARION COUNTY BUILDING ENSPECTI <br /> <br />FOR C1TY ~ALIDA.~'ION[ 285 Church St ~E* Room 132 O: <br />R~i'vcd b~~.l Salem, OR 97~01 U L 1 6 1996 <br />D~: ~¢//.~./q~ I z4,..,.,p.,tin. L,..37~,4:7 O~t.: MARION COUNTY <br /> om~: Pheae 588-S147 8:0bm - 4:30pm <br /> FAX: <br /> <br />PLUMBING PERMIT APPLICATION <br />Please complete all Sections, I through <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />~ ARE NON-TRANSFERABLE AHD EXPIRE IF WOP~ IS NOT <br /> STARTED wrrHIN lg0 DAYS OF ISSUANCE OR IF <br /> I <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />[Vl. aili~[ Addt~s <br /> <br />Plu~nbing Bo~d: <br />Cootraotor's Board Reg. No. [ ~ob No. <br />Journeyman's Plumbe~ No. <br />Ce~ractor's Signature: <br /> <br />2B. FOR OWNILR INSTALLATION8 <br /> <br />Agent's Signato~: <br /> <br />4. NBB SCHBDULB (Complete and enter total in Al below) <br /> <br /> RB~IDENTIAL lip/ COMMERCIAL [] <br /> USB OF STRUCTURE: <br /> NEW C2 ALTERATION m ADDITION 12 RELOCATION <br /> <br /> Ho. X F~ ~ ,~m <br />BASE FEE $20.00 <br /> <br />RE$11~,HTIAL (~ch fLXtUr~) <br /> Aurorn Dwelling Plumbing Fee __sq. ft. x $.070 <br /> <br />Single Family or muhi-fnmily per <br />dwelling unit <br />New construction $10.00 <br />Alterations $10.00 <br />Recoi'mect $ 5.00 <br />Relocnt~l 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 />m~cimum of 500 ft.) $15.00 <br /> <br />Sanitary & Stoan Linen <br />First 100 ft. or traction thereof $30.00 <br />For addnl' 100 ft. (up to <br />m~ximum of S00 fi.) $15.00 <br /> <br />COMMBRCIAL (each f~cmre) <br /> <br /> N~w construction $10.00 <br /> Alterations $10.00 <br /> Re,~onno~t $10.00 <br /> <br />Water ~ <br />First 1(30 ft. or fraction Ih¢i'~of $25.00 <br />For eh. addnl' 100 ft. <br /> <br />Sanitary & Su~m Line~ <br /> Ftrst 100 fi. or fraction ~hcreof <br /> For addnl' 100fl. <br /> <br />PROTECTIVE BACKFLOW DBVICE <br /> Lawn vacuum breaker (sprinkler systom) <br /> All others <br /> <br />$15.00 <br /> <br />$15.00 -- <br /> <br />$4.50 <br />$10.00 <br /> <br />OTlt~R (as t~quiced b..s, OSPSC <br /> and B~ilding 01~eiaO <br /> <br />DWELLINO PERMIT LABEL //oft,abels <br /> <br />N/C <br /> <br />3. PLANRE¥1itW 8BCTION <br /> <br />Marion County does not require a plan review. <br />We will provide plan review service if you complete <br />Section SB 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. FBBS <br /> Al. En~r to,hi of fees from S~. fi4 <br /> A2. Add 5% su~harge $05 x A 1) <br /> ~bt~l <br /> <br /> ~t=r ~ o; i~ ~i for e~ <br /> <br /> C. l~estigat~n ~ (ifmq~ <br /> D. ~p~tbn F~ ($25.~) <br /> <br /> ~ ~T~ ~O~ D~ <br /> Re~ipt <br /> No. <br /> <br />$__ <br />$__ <br /> <br /> <br />