Laserfiche WebLink
[~FOR CITY VALIDATION] <br /> <br /> MARION COUNTY <br />BUILDING INSPECTION DIVISION <br /> <br />3150 Lancaster Dr. NE - Suite C <br />Salem, Oregon 97305-1398 <br /> <br /> Office: Opm <br /> <br /> PLUMBING PERMIT APPLICATION <br /> Please complete all Sections, I through 5I MARION <br /> BUILDING <br />1. LOCATION OF INSTALLATION <br /> TAXACCO TNO' I '1 12 1--10 Ioi° <br /> <br />' PROPER~ O~ER ~ <br /> <br /> / <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK 1S NOT [ <br /> I <br /> STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br /> Plumbing Contractor <br /> <br /> Mailing <br /> Address <br /> P.O 45 Io 1-17 <br /> PAX te;I B I-I <br /> PLU~ING BO~ ~O. <br /> <br /> CO~CTORS BO~ x <br /> <br /> III <br /> PLU~ERS NO. <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br />/ · <br /> .111 <br /> <br /> Property Owner (please prin0 <br /> <br /> Mailing Address <br /> <br /> City, State, Zip <br /> <br /> Owner's Signature <br /> <br /> Agent's Signature <br /> <br />3. PLAN REVIEW 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 15-45 7/97 <br /> <br />PERMIT NO: <br />Date: <br /> <br />Issued by: <br /> <br />~CHEDULE (Complete and enter total in 5-Al below) <br />IN~}~L {~ COMMERCIAL {~ USE: <br /> NEW ~ ALTERATION rl ~mT~ON ~ RELOC^T~ON {~ <br /> <br /> BASE FEE Assessed on all applications $20.00 <br /> (Exception: Water/Sewer Line Applications w/no f~mrcs) <br /> <br />AREA DRAiN <br />BACKFLOW PREV DEVICE <br />BATHTUB <br />BIDET <br />CATCH BASiN <br />CLOTHES WASHER <br />DENTAL UNIT <br />CUSPIDOR <br />DRINKiNG FOUNTAIN <br />FLOOR DILMN <br />OTHER <br /> <br />OTY OTY <br /> INTERCEPTOR <br />~- LAUNDRY TUB <br /> RECEPTOR <br /> SHOWER <br /> SINK <br /> TROUGH DRArN <br /> TUB/SHOWER <br /> URINAL <br /> WATER CLOSET <br /> WATER HEATER <br /> WET BAR <br /> <br /> Total # Fixtures x $10.O0 = $ <br />Lawn vacuum breaker / sprinkler system I x $4.50 = $ <br /> <br />WATER LINES <br /> Residential: First 100 ff. Or fraction thereof -- x $20.00 = $__ <br /> For ea addnl lo0 ~ Up to 500 feet __ x$15.00 =$__ <br /> Commercial: First lo0 ff. Or fraction thereof x $25.00 = $ <br /> For ea addnl 100 feet x $15.00 = $ <br /> <br />SANITARY SEWER LINES <br /> Residential: First l00 ft. Or fraction thereof x$30.00 =$ <br /> For ea addnl IO0 ft. Up to 500 feet -- x $15.00 <br /> Commercial: First 100 ff. Or fraction thereof x $30,00 = $ <br /> For ea addnl IO0 feet x $15.00 = $ <br /> <br />STORM DRAINS <br /> Residential: First 100 ff. Or fraction thereof x $30.O0 = $ <br /> Foreaaddnllo0ff. Up to 500 feet -- x$15.00 =$__ <br /> Commercial: For 100 R. Or fraction thereof x $30,00 = $ <br /> For ea addnl IO0 feet x $15.00 = $ <br /> <br /> =$ <br /> <br />MINOR INSTALLATION LABELS x $50.00 <br />(Pack of 10 labels (~ $5.00 each, sold only to Plumbing con~ractors) <br /> <br />~I~3-~[~/.1~ # of Labels -- <br />(For New Single Family Dwellings Only) <br /> <br />N/C <br /> <br />5. FEES <br />AI.Entertotatoffee~fmmSee.#4 $ ~_~t./g ~ <br />A2. Add 5% sumh~ (.05 x Al ) $ / ~ <br /> Subm~l $ ~ ~ 7~ <br /> <br /> (Al + .25), if~ui~d ~-~ ~ $ <br /> C. Investi~fion Fee (if ~qui~) $ ~ <br /> D. Reinspection F~ ($25.00) $ ~/ <br /> <br /> <br />