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FOR CITY VALIDATION[ <br />R~ivzd 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 3734427 <br />Office: Phone 588-5147 8:00am - 4:30pm <br />FAX: 588-7948 <br /> <br />PLUMBING PERMIT APPLICATION <br />Please complete all ~ections, I through <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />2A. CONTRACTOR INaTALLATION ONLY <br /> <br />PimnbingBoard: ~ -- ~ 3~ ~)~ , <br />Coratactor's Board Reg. No. ~C~ ~ [ Job No. <br /> <br /> FOR OWNER INSTALLATIONS <br />PeopeCcy Owner (p/~se print) <br /> <br />Mailing Address ] Phone <br />City/State/Zip <br />Owner's Signature: <br />Agent's Signature: <br /> <br />3. PLANRE¥1BW SECTION <br /> <br />Marion County does not require a plan review. <br />We will provide plan review service if yon 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 />PEl:lMff NO: <br /> <br />D~o: <br /> <br />Issued by: <br /> <br />4. FBB 8CHEDULE (Complete and eme~ total in A1 bolow) <br /> RBSIDBNTIAL~ COMMERCIAL ~ <br /> USE OF STRUCk: <br /> NEW 12 ALTERATION~ ADDITION/2 RI/LOCATION <br /> <br />BAS~ FEE $20.OO <br /> <br />RESIDENTIAL (each fixture) <br /> Amora Dwelling Plumbing Fee __.sq. ft. x $.070 <br /> <br />Single Family or multi-family per <br />dwelling unit <br />New construction $10.00 <br />Alterations T $10.00 <br />Reconnect $ 5.00 <br />Relocated Structure $ 5,00 <br />Modular S~ructure $ 5.00 <br /> <br /> Fu~t 100 ft. or fraction ahereof $20.00 <br /> For ca, addnl' 100 fi. (up to <br /> maximum of 500 ft.) $15.00 <br /> <br /> Fa'at 100 fi, or fraction thereof $30.00 <br /> For addnl' 100 ft, (up to <br /> maximum of 500 f13 $15.00 <br /> <br />COMMERCIAL (each fixture) <br /> <br /> New construction $10.00 <br /> Alterations $10.00 <br /> Ra~onnect $10.00 <br /> <br />Wator Lines <br />F'gat 100 fL or fractioa ~hcmof $25.00 <br />For ea. addrd' 100 ft. <br /> <br />Sanitary & Storm Linea <br /> First 100 ft. or fraction thereof <br /> For ad~l' 100 fl. <br /> <br />$15,00 -- <br /> <br />$15.00 -- <br /> <br />PROTECTIVE BACKFLOW DEVICE <br /> Lawn vacuum breaker (sprinkler system) <br /> All others <br /> <br />$4.50 -- <br />$10.00 __ <br /> <br />OTHER (ssceq~cedbyOSPSC <br /> <br />DWELLINO PERMIT LABEL # of Labeh <br /> <br />5. FEES <br />Al. Enl~r total of fees from S~.//4 $.__ <br />A2. Add 5% surcharge (.05 x Al) $,__ <br /> <br /> B. ~ter 25% of l~e Al for PI~ ~ <br /> (Al + .25), if~ $.__ <br /> C. l~fign~n Fee (if~d) $.__ <br /> <br /> TOT~ ~O~ D~ $.~ <br /> Rec6pt No. <br /> <br /> <br />