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FOR CITY VALIDATION[ <br />R~ooived by: <br />Date: <br /> <br />MARION COUNTY BUILDLNG INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> 285 Church St NE · Room 132 <br /> Salem, OR 97301 <br /> <br />PLUMBING PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />l. LOCATION OF II~ISTALLATION <br /> <br />ARE NON-TRANSFERABLE AND EXPIRE 1F WORK I~ NOT <br />STAR'I~.D WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />ffoum~nnn's Plumbers No. ~ <br />Conlractor's Signature: ~~ <br /> <br />2B. FOR OWNItR INSTALLATION8 <br />Prop~y Owner (ple~ prim) <br />Mailing Addr~m ] Phon~ <br />Cily/S tete/Zip <br />Own~es $ignatm'e: <br />A~nt's Signature: <br /> <br />D~: <br /> <br />24 hr. Inspection Line 373-4427 <br />Office: Phone 588-5147 8:00am - 4:30pm I~sued by: <br />FAX: 588-7948 <br /> <br /> 4. la'Ii SCH~DUL~ and total in A 1 <br /> (C~mpl~te <br /> below) <br /> <br /> Rr~IDBNTIAL [] COM~BRCIAL <br /> USli OF 8TRUCTURlt: <br /> NEW I~1 ALTERATION I~ ADDITION <br /> <br /> No. X Fa = 8urn <br /> BASE FEE $20.00 <br /> <br /> RESIDENTIAL (each f~xtur~) <br /> Aurora Dwelling Plumbing Feo __.sq. ft. x $.070 <br /> <br /> Single Family or multi-family p~r <br /> dwelling unit <br /> New construction $10 <br /> Alterations $10,00 -- <br /> Reconnect $ $.00 -- <br /> Relocated Structure $ $.00 -- <br /> Modular Stmctur~ $ $.00 <br /> <br /> First 100 fi. or fraction thereof $20.00 -- <br /> For oa. addnl' 100 fL (up to <br /> maximum orS00 ft.) $15.00 -- <br /> <br /> Sanite,~ & Storm Lines <br /> Pint 100 t'L or fr~¢tion thereof Sa0.00 <br /> FOr addnl' 100 fl. (up I~ <br /> msXm~um of $00 ft.) $15,00 __ <br /> <br /> COMMERCIAL (~h t'ixtur~) <br /> <br /> N~v consLruction $10.00 -- <br /> Alt~ratio~ $10.00 __ <br /> Roconn~t $10.00 -- <br /> <br /> Fint 100 ft. or fraction thereof $25.00 -- <br /> For ea. addnl' 100 fi. <br /> $15.00 -- <br /> <br /> $anitary& Storm LIO~ <br /> First I00 fi. or fraction th~'~of $30.00 -- <br /> For zddnl' 100 ft. <br /> $15.00 -- <br /> <br /> Lawn vacuum breaker (aplinkl~r system)__ $ 4.~0 -- <br /> AIl othexs $10.00 -- <br /> <br /> OTHER (as req~irod by OSPSC <br /> and Builff~ng Or'ciaO -- <br /> DWELLINO FERMrr LABEL # of I~buls <br /> <br />3. PLANREVIIiW 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 />R~v. 1/96 <br /> <br />Al. Enter total of fees fi'om Sec. <br />A2. Add 5% surcharge (.05 x Al) <br /> <br />B. Enter25% oflioe Al for Plan Review <br />(Al + .25), if required $. <br />C. Investigation Fee (ifrequireal) $. <br />D. Relmpeetion Fee ($25.00) $. <br /> <br /> TOTAL AMOUNT DUE ~ <br />Receipt No. <br /> <br /> <br />