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IFOR CITY VALIDATION <br /> Re~eivexl 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 8:00am - 4:30pm <br />FAX: 588-7948 <br /> <br />PLUMBING PERMIT APPLICATION I <br />Please complete all Sections, I through 5 <br /> I <br /> <br />'" 1. LOCATION OF INSTALLATION <br /> <br />Job Addr~s <br /> <br />Cross Street/Direction: <br /> <br /> pERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT I <br /> STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> I <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A.' CONTRACTOR INSTALLATION ONLY <br /> <br />Mailing Address 1~05 ~AO[L~'~I__ ~)tl~.._ G~--~ <br /> <br />Plumbing Board: <br /> <br />liB. FOR OWNBR INSTALLATIONS <br /> <br />Property Owner (plas so print) <br /> <br />PERMIT NO: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />Mailing Address I Phone <br />City/State4Zip <br />Owner's Signature: <br />Agent's Signature: <br /> <br />3. PLAN REVIEW SECTION <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 />4. FEE SCHEDULE (Complete and em~ total in Al below) <br /> <br /> RESIDENTIAL ~ COMMERCIAL <br /> <br /> USE OF STRUCTURE: <br /> NEW [3 ALTERATION I~ ADDITION CI RELOCATi~ON n <br /> No. X Fee~=$~ <br />BASE <br /> FEE <br /> /\ <br />RESIDENTIAL (each fixture) <br /> <br /> Aurora Dwelling Plumbing Fee __ sq. ft. x $.070 - <br /> <br />Single Family or multi-family par <br />dwelling unit <br />New construction $10.00 __ <br />Alterations $10.00 -- <br />Reconnect $ 5.00 -- <br />Relacalcd Structure $ 5.00 -- <br />Modular Structure $ 5.00 -- <br /> <br />Water Lines <br /> First 100 fl. or fraction thereof <br /> For ea. addnl' 100 ft. (up to <br /> maximum orS00 ft.) <br /> <br />Sanitary & Storm Lines <br /> First 100 ft. or fraction thereof <br /> Foraddnl' 100 ft. (up to <br /> maximum of 500 fl.) <br /> <br />COMMBRCIAL (each ftxture) <br /> <br /> New construction <br /> Alterations <br /> Reconnect <br /> <br /> $20.00 -- <br /> $15.00 -- <br />\ $3ooo'5 - <br /> <br />$10.00 -- <br />$10.00 -- <br />$10.00 -- <br /> <br />First 100 ft. or fraction thereof $25.00 -- <br />For ea. addnl' 100 fl. <br /> $15.00 __ <br /> <br />Sanitary &Stonn I~mes <br />Fimt 100 fl. or fraction thereof $30.00 -- <br />For addnl' 100 ft. <br /> $15.00 -- <br /> <br />PROTECTIVE BACKFLOW DEVICE <br />Lawn vacuum breaker (sprinkler system) $ 4.50 -- <br />All others $10.00 -- <br /> <br />OTHER (as reqaired by OSP$C <br /> and Building O£~ciaD <br /> <br />DWELLING PERMIT LABEL # of Labels <br /> <br />N/¢ <br /> <br />5. FEES <br />A l, Enter total of fees from See.//4 $,__ <br />A2. Add5% sureharg~ (.05 x Al) $.__ <br /> Subtotal $.__ <br /> <br /> B. Eater 25% of lineAl forPlanRevinw <br /> (Al + .25), if required $ <br /> C. Investigation Fee (if required) <br /> D. Reinspeetion Fee ($25.00) $__ <br /> <br /> TOTAL A/vlOUNT DIJE $.__ <br /> Receipt No. <br /> <br /> <br />