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COMMUNITY DEVELpyMENT CENTER ~MIT' a{l'/e ~nn~ "~ <br /> 25S Church St NE Room 132 ~U~O} ~ ~oo~ <br />FOR CITY VALIDA'HON] ~ <br />Re~ive~ by:~~'[ ~' Salem, OR 97301 . <br /> Oat~lAa;0;,~ COUi',iT¥ <br />D~t.: ~ (6-C~7 ] I~{~{,~t{'~. INSPECTION <br /> <br /> 24 hr. Inspection Line 373-4427 <br /> Office: Phone 588-5147 8:00am - 4:30pm <br /> FAX: 588-7948 <br />PLUMBING PERMIT APPLICATION I <br /> I <br />Please complete all Sections, I through 5 <br /> <br />1. LOCATION OF I~STALLATION <br /> <br />PERMrr$ ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT <br />STARTEd) WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 1~0 DAYS. <br /> <br />?.,A. CONTRACTOR I~STALLATION ONLY <br /> <br />Mailing Addr~s <br /> <br />Plumbing Bom'd: <br /> <br />Joumeymna's Plumbers No. <br /> <br />2B. FOR OW'NER INSTALLATIONS <br /> <br />Asnt's Signature: <br /> <br />4. FEE SCHBDULB (Completo and eme~ total in Al below) <br /> <br /> RBSIDILNTIAL ~, COMMtLRCIAL [] <br /> U81t ,O~,STRUCTURIi: <br /> NEW ~[ ALTERATION CI ADDFFION [2 RELOCATION <br /> <br /> No. X F~ = Sum <br /> <br /> Amora Dwelling Plumbing Fee __.sq. iL x $.070 = <br /> <br />Single Family ~ multi-family per <br />dwelling unit <br />New construction $10.00 -- <br />Alterations $10.00 __ <br />Reconnect $ $.00 -- <br />Relooated Struotur¢ $ $.00 -- <br />Modular Struetur~ $ 3.00 __ <br /> <br />Water Lines <br />First 1~0 ft. or fraction thereof $~0.00 -- <br />For ea. addnl' 100 fl. (up to <br />maximum of S00 iL) $15.00 -- <br /> <br />Sanitary & Strum Linea <br />Fkst 100 iL or fractinn thereof $30.00 -- <br />For nddnl' 100 ft. (up ~ <br />maximum of $O0 il.) $15.00 -- <br /> <br />COMMERCIAL (each fixture) <br /> <br /> New construction $10.00 -- <br /> Alteratiom $10.00 -- <br /> Reoonn~ct $10.00 <br /> <br />Watar Lin~ <br />l~irst 100 iL or fra~tinn thereof $2~.00 -- <br />Foroa. adg~l' 100 ft. <br /> <br />Sanitary & Storm IAn~ <br /> Pi~t 100 iL or fraction thereof <br /> For addnl' 100 ft. <br /> <br />$15.00 -- <br /> <br />$15.00 <br /> <br />l.~wn vacuum breaker (sprinkler system) $ 4.50 -- <br />All other~ $10.00 -- <br /> <br />OTHER (as reqaired by O~P$C <br /> and Bud~ng O~cial) <br /> <br />DWBLL1NO PERblrr LABEL # of Lnbele NIC <br /> <br />3. PLANRBVIBW SBCTION <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 />5. FEES <br /> Al. Enter total offo~ from SeC,//4 <br /> A2. Add 5% surcharge (,05 x Al) <br /> ~ubtotal <br /> <br /> B. Enter25% of lineAl forPlnn Review <br /> D, Reinspection Fee ($25.00) $__ <br /> <br /> Receipt <br /> No. <br /> <br /> <br />