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FOR CITY VALIDATION <br />Ie'ec¢ived By: I <br /> <br /> MARION COUNTY <br />BUILDING INSPECTION DIVISION <br /> 3150 Lancaster Dr. NE - Suite C <br /> Salem, Oregon 97305-1398 <br /> <br /> 24 HR Inspection Line 373-4427 <br />Office: phone 5~8-$147 8:00am - 4:30pm <br />FAX 588-7948 <br /> <br />Issued by: <br /> <br /> PLUMBING PERMIT APPLICATION <br />P/ease complete all Sections, 1 through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT <br />STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />2B. FOR OW3N-ER INSTALLATIONS <br /> <br /> Property Owner (please print) <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 />MC15-457/97 ~e6 ~ ~ g <br /> <br />4. FEE SCHEDULE (Complete and enter total in 5-Al below) <br />RESIDENTIAL ~ COMMERCIAL [~ USE: <br />NEW ~ ALTERATION ~l ADDITION ~ RELOCATION <br />BASE FEE Assessed on all applications /~ <br /> (Exception: Water/Sewer Line Applications w/no fix et~ltR~ <br /> <br />FIX~RES OTY O3'Y <br />AREA DRAIN INTERCEPTOR <br />BACKFLOW PREV DEVICE LAUNDRY TUB <br />BATHTUB ~ RECEPTOR <br />BIDET SHOWER I <br />CATCH BASIN SINK ] I I <br />CLOTHES WASHER TROUGH DRAIN <br />DENTAL UNIT TUB/SHOWER <br />CUSPIDOR BRINAL <br />DRINKING FOUNTAIN WATER CLOSET <br />FLOOR DRAIN WATER HEATER ~ <br />OTI-I~R WET BAR <br /> <br /> Total#Fixtures ~ x $10.00 = $~_ ~}~ ~ <br /> Lawnvacuumbreaker/sptinklersystem -- x $4.50 =$__ <br /> <br /> Residentiat: First 100 g., Or fractlon thereof x$20.00 =$__ <br /> Foreaaddnl 100 ff Up to 500 feet -- x$15.00 <br /> Commercial: First 100 1t. Or fraction thereof x $25.00 = $ <br /> For ca addn1100 feet x $15.00 = $ <br /> <br /> Residential: First 100fcOrfiactiontbereof x$30.00 =$ <br />~ Foreaaddnll0Off. Up~oSOOfeet -- x$15,00 =$__ <br /> Commercial: First 100 ft, Or fraction thereof x $30,00 = $ <br /> For ea addn1100 feet x $15,00 = $ <br /> <br /> STORM DRAINS <br /> Residential: First 100ft. Or fraction thereof x$30.00 =$ <br /> Foreaaddnl 100 ~. Up to S00 feet -- x$15.00 <br /> Commercial: For 100 ~. Or fraction thereof x $30.00 = $ <br /> For ea addnl 100 feet x $15.00 = $ <br /> <br /> MINOR INSTALLATION LABELS x $50.00 = $ <br /> (Pack of 10 labels ~ $5.00 each, sold only to Plumbing contractoes) <br /> <br /> ~ # of Labels N/C <br /> (For New Single Family Dwellings Only) <br /> <br />$. FEES <br /> Al. Enter tara] of fees from Sec. 84 <br /> A2. Add 5% surcharge (.05 x A 1 ) <br /> <br />B. Emir 25% of line Al '/or Plan R,view <br /> (Al + .25), if required <br />C. Investigation Fee (ifrequlred) <br />D. Reinspect ion Fee ($25.00) <br /> <br />Receipt No. __ <br /> <br />Subtotal $ <br /> <br />TOTAL AMOLINT DLrE <br /> <br /> <br />