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FOR CITY VALIDATIONI <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 373-4427 <br />Office: Phone 588-5147 8:00am-4:3Opm <br />FAX: 588-7948 <br /> <br />PLUMBING PERMIT APPLICATION <br />Please complete all Sections, I through <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />PERMITS ARE NON-TRANSFERABLE AND F.,XPIRE IF WORK IS NOT <br />STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. coBrTRACTOR INSTALLATION ONLY <br />Conu-ector~ I Phone <br /> <br />Contractor's Board Reg. No~ <br /> <br />Journeyman's P]umbem No. <br /> <br />I Job No. <br /> <br />FOR OWNER INSTALLATIONS <br /> <br /> r <br /> <br />PERMIT NO: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />4. FEE SCHEDULE (Complete and enter tol~l in A 1 below) <br /> <br /> RT:~IDBlqTIAL ~I- C OMMFffiC IAL 0 <br />use sT uc a . : <br />NEWIi~ ALTERATION 121 ADDITION m RELOCATION <br /> <br /> No. X Fee = Sum <br />BASE FEE $20.0O <br /> <br />RESIDENTIAL (each fixture) <br /> Aurora Dwelling Plumbing FO~ __.sq. iL x $.070 - <br /> <br />Single Family or multi-family per <br />dwelling unit <br />New construction $10.00 <br />Alterations $10.00 <br />Reconnect $ 5.00 <br />Relocated Structure $ 5.00 -- <br />Modular Structure $ $.00 -- <br /> <br />Water Lines <br />Fint 100 fi. or fraction ~er~of $20.00 -- <br />FOr ea. addul' 100 ft. (up to <br />maximum orS00 ft.) $15.00 -- <br /> <br />Sanitary & Storm Lines <br />Fret 100 iL or fraction thereof $30.00 -- <br />For addu[' 100 fi. (up to <br />maximum of 500 iL) $15.00 <br /> <br />COMMERCIAL (each fixture) <br /> <br /> New construction $10.00 -- <br /> Alterations $10.00 <br /> Reconnect $10.00 <br /> <br />Water Lines <br />First 100 ft. or fraction thereof $25.00 <br />For ea. addul' 100 ft. <br /> $15.00 <br /> <br />Sanitary & Storm Lines <br /> First 100 ft. or fraction thereof <br /> For addul' 100 iL <br /> <br />$30.00 <br /> <br />$15.00 <br /> <br />PROTECTIVE BACK]PLOW DEVICE <br />Lawn vacuum breaker (sprinkler system) $ 4.50 -- <br />All others $10.00 <br /> <br />OTHER (as required by OSP, gC <br /> and Building OFdciaD <br /> <br />DWELLING PERldlT LABEL # of Labels <br /> <br />N/C <br /> <br />3. PLANREVIEW SECTION <br /> <br />Marion County does not require a plan review. <br />We will provide plan review service if you complete <br />Section 5B and submit two (2) sets of plans and <br />specifications with this application. <br /> <br />MC I$-45 <br />Rev. 1/96 <br /> <br />5. FEES <br />A I. Enter total of foes from Sec. g4 $.__ <br />A2. Add 5% surcharge (.05 x Al) $.__ <br /> Subtotal $.__ <br /> <br /> B. Enter 25% of line A 1 for Plan Roview <br /> (Al + .25), if r~quired $.__ <br /> C, Investigation Fee (if required) $.__ <br /> D, Reimpection Fo* ($25,00) $ <br /> <br /> TOTAL AMOUNT DUE $ <br /> Receipt No. <br /> <br /> <br />