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MARION COUNTY BUILDING INSPrlCTION <br /> <br /> COMMUNITY DEVELOPMENT CENTER <br />FOR C1TY VALIDATION] 285 ChurchSt NE' Room 132 pI~RMIT NO: ~'~/ - (~6,~ q <br />Received by: Salem, OR 97301 Date: <br />Date: 24 Hr Inapo~tion Line: 588-7904 <br /> <br />PLUMBING PERMIT A .P. PLICATI(Ji~ ! L.~ <br />Please complete all Sections, lthroughS',l~N ! ? 974. F~'~SCHEDULR(Complet~ndent~m~al~nAlbelow) <br /> ~S~Dm,rHAL ~ COMM~a~CIAL ~ <br /> 1. LOCATION OF INSTALLATION MARIONCO] !T~Y USR OF STRUCTURE: ..- <br /> RIII1131M~ Ibl ~TI0~wD ALTERATIONgt'~ADDITION~'~ELOCATiON ~1 <br /> <br />PER/VRTS ARE NON-TRANSFERABLE AND EXPIRE IF WORK iS NOT <br />STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPI~IDE~ FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />2B. FOR OWNBR nqSTALLATION$ <br /> <br />I~operty Owner (plea~ prilg) <br /> <br />Mailing Address I Phone <br />City/State/Zip <br /> <br />Agent's Signature: <br /> <br />3. PLANRBVIEW SI~CTION <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 /> No. X PM ~/~.~ ) <br />BASE <br /> FEE <br /> <br />RESIDENTIAL (each fixture) <br /> Aurora Dwelling Plumbing Fee sq, ft, x $.065 = <br /> <br />Single Family or multi-family per <br />dwelling unit <br />New constmction ~ $10.00 _ ~_~.. <br />Alterations $10.00 <br /> Reconnect $ 5.00 -- <br /> Modular Saructure $ 5.00 <br /> <br /> maximum of S00 ft.) $15.00 <br /> maximum orS00 ti.) $15.00 <br /> <br />PROTECTIVE BACKFLOW DEVICE <br /> Lawn vacuum breaker (sprinkler system) <br /> All o~hers <br /> <br />OTHER (as t~tuiredbyOSP~C <br /> and Budding Ol~ciaO <br /> <br />$15.00 <br /> <br />$30.00 <br /> <br />$15.00 <br /> <br />$4.50 <br />$1o.oo __ <br /> <br />DWELLING PERMIT LABEL # of Lal~ls N/C <br /> <br />MC 1.$45 <br /> <br />5. FEES <br />Al. Enter ~otal of fees from See. g4 <br />A2. Add 5% surcharge (.05 x Al) $.~_-~'~" <br />Subtotal <br /> <br /> B. Emir 25,% of line A1 for Plan Review <br /> (Al + .25), if r~quimd $___ <br /> C. Investigation Fee (if required) <br /> D. Rehapeetion Fee ($25.00) $.__ <br /> <br /> TOTAL AMOUNT DUE <br /> Receipt No, <br /> <br /> <br />