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FOR CITY VALIDATION <br />Received 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: 588-7904 <br />Off'ge: 588-5147 8:00~m. - 4:30p.m. <br />FAX: 588-7948 <br /> <br />IPLUMBING PERMIT APPLICATION <br /> Please complete all Sections, I through <br /> <br /> 1. LOCATION OF INSTALLATION <br /> <br />PERMITS ARE NON-TRANSFF~RABLE AND EXIHRE IF WORK IS NOT <br />STARTED WITmN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />2B. FOR OWNHR INSTALLATIONS <br /> <br />Pwperty Owner (please prim) <br />Mailing Addreas I Phone <br /> <br />City/Stata/Zip <br /> <br />Agent's Signature: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />4. FEE $CHRDULE (Complete and ente~ total in Al below) <br /> <br /> RESIDENTIAL {2 COMMERCIAL Q <br />USE OF STRUCTU4~I/: <br />NEW (2 ALTERATION (2 ADDITION o RELOCATION <br /> <br />~ NO. X Fe~ -- 8urn <br />BASE FEE $20.00 <br /> <br /> RBSlDENTIAL (e~eh fixture) <br /> Aurora Dwelling Plumbing Fe~ sq. fl, x $.06~; -- <br /> <br /> Single Family or mplti-family per <br /> dwelling unit <br /> New construction ~ $10.00 ~0'00 <br /> Alterations $10.00 -- <br /> Reconnect $ 5.00 <br /> Relocated Structure $ $.O0 <br /> Modular Structur~ $ 5.00 <br /> <br /> Water Lines <br /> Firat 100 ft. or fraction thereof $20.O0 -- <br /> For ea. 8ddul' 100 fL (up to <br /> mBximmnofS00 R,) $15.00 -- <br /> <br /> Sanita~ & Stonu lAn~6 <br /> First IO0 ft. or fraction thereof $30.00 -- <br /> For addnl' IO0 ft, (upto <br /> maximum of 500 ft.) $15.00 -- <br /> <br /> COMMERCIAL (e~¢h fmture) <br /> <br /> New construction $ I0.00 <br /> Altaratiom $10.00 -- <br /> Reconnect $10.00 <br /> <br /> Wnter Lines <br /> First 100 fl. or fraction thereof $25.00 -- <br /> For ~n. nddu[' 100 ft. (up to <br /> maximum of 500 ft.) $15.00-- <br /> <br /> Snnitary & Storm Line~ <br /> First 100 ft. or fraction thereof $30.00 <br /> For addnl' 100 f~ (up to <br /> maximumof500 ft.) $15.O0 -- <br /> <br /> PROTECTIVE BACKInLOW DEVICE <br /> Lawn vacuum breaker (spfiakler ~ystem) $ 4.50 -- <br /> All others $10.00 -- <br /> <br /> OTHER (#~ required by OSPSC <br /> ~nd Building Ol~¢i~O <br /> DWELLING PERMIT LABBL # of Labels NIC <br /> <br />3. PLAN 1LEVIEW 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 1545 <br />Rev. <br /> <br />5. FEBS <br />Al. Enter total of fees f~m Sec. #4 i ,~O~ <br />A2. Add 5% surcharge (.05 x Al) <br /> Sabtotal <br /> <br /> B. Erect25% of'line A1 for Plan Review <br /> (Al + .25), if required $.__ <br /> C. lnvesligation Fee (if requiwxl) $.__ <br /> D. Reimpection Fee ($25.O0) $.__ <br /> TOTAL AMOUNT DUE $ g ~ O ~ <br /> Receipt No. <br /> <br /> <br />