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FOR CITY VALIDATION <br />Received by: <br />Date: <br /> <br />MARION COUNTY BUILD~NG I~SPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> PERMIT NO: <br /> 285 ~2hurch St NE ' Room 132 <br /> (~// Salem, OR 97301 Date: <br /> 24 hr. Inspection Line 373-4427 <br /> Office: Phone 588-5147 S:O0am - 4:30pm leeued by: <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 EXPIRE IF WOP,~ IS NOT <br /> STARTED WITHIN 1~0 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />Mailing Address [ Phone <br />City/State/Zip <br />Owner's Signature: <br /> <br />Agent's Sigtmmre: <br /> <br />3. PLANREVIEW SECTION <br /> <br />Marion County does not reqmre 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 ent~ total in A1 below) <br /> <br /> RESIDEN'rIAL ~ COMMERCIAL [] <br /> USE OF STRUCTURE: <br /> NEW El ALTERATION [3 ADDITION El RELOCATION <br /> <br />BASE FEE <br /> <br />RESII)~[~ NTIAL (each fixture) <br /> <br /> New construction $19.00 <br /> <br />Water Lines <br />First 100 fl. or fraction thereof $20.00 <br />For ea. addnl' 100 il, (up to <br />maximum of 500 ft.) $15.00 <br /> <br />For addnl,' 100 ft. (upIo <br />maximum of 500 fi.) <br /> <br />$30,.00 <br /> <br />$15.00 <br /> <br />$10.00 <br />$10.00 <br />$10.00 <br /> <br />Water Lines <br /> First 100 fl. or fraction thereof <br /> For ea. addnl' 100 il. <br /> <br />$25.00 <br /> <br />$15.00 <br /> <br />Sanitary & Storm Lines <br /> <br />$30.00 <br /> <br />$15 <br /> <br />PROTECTIVE BACKFLOW DEVICE <br /> Lawn vacuum breaker (sprinkler system) <br /> All others <br /> <br />$ 4.50 <br />$10.00 <br /> <br />DWELLING PERblIT LABEL # of Lal~ls <br /> <br />5. FEES <br /> A 1, Enter totalxff fees from Sec. #4 <br /> A2. Add 5% stireharg~ (.05 x Al) <br /> Subtotal <br /> <br />B. Enter 25% of line A 1 for Plan Review <br /> (Al + .25), if required <br />C. Inv¢sligation Fee (if r~quir~d) <br />D. Reieapeetion Fee ($25.00) <br /> <br /> TOTAL AMOLrNT DUE <br />Receipt No. <br /> <br /> N/C <br /> <br />$ <br /> <br />$ <br />$ <br />$ <br />$. c~/, ~o <br /> <br /> <br />