Laserfiche WebLink
FOR CITY VALIDATIONl <br />Received By: <br /> <br />Date: <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 588-5147 8:00am - 4:30pm <br />FAX 588-7948 <br /> <br /> PLUMBING PERMIT APPLICATION I <br />Please complete all Sections, 1 through 5 <br /> I <br /> <br />1. LOCATION OF INSTALLATION <br /> <br /> TAX ACCOUNT NO. <br /> <br /> JOB ADDRESS <br /> <br />CITY <br /> <br />PROPERTY OWNER <br /> <br />OWNER'S <br />PHONE # <br /> <br />CROSS STREET/DIRECTIONS <br /> <br />PROJECT DESCRIPTION <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 /> Plumbing Contractor /~,"t../ ~ <br /> Mailing / <br /> Address City <br /> PHONE m ~ <br /> <br /> CONTRACTOR'S SIGNATURE <br /> <br />2B. FOR OWNER INSTALLATIONS <br />PropettyOwner(pleaseprinO ~'~ <br /> <br /> City' State' zip '~ bc~ ~0 ~ ] 1~ ~ <br /> I-I <br /> ~nersSigna~re (/~ ~ ~ <br /> Agent's Si~atore ~ <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 />PERMIT NO: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />4. FEE SCHEDULE (Complete and enter total in 5-Al b~low) <br />RESIDENTIAL [~ COMMERCIAL O USE: <br /> <br /> NEW [] ALTERATION [] ADDITION [] RELOCATION [] <br /> <br />BASE FEE Assessed on att applications $20.00 <br /> (Exception: Water/Sewer Line Applications w/no fixtures) <br /> <br />FIXTURES OTY OTY <br />AREA DRAIN INTERCEPTOR <br />BACKFLOW PREV DEVICE LAUNDRY TUB <br />BATHTUB J RECEPTOR <br />BIDET SHOWER <br />CATCH BASIN SINK <br />CLOTHES WASHER TROUGH DRAIN <br />DENTAL UNIT -- ~ ...... ~c. · <br /> <br />DRINKING FOUNTAIN WATER CLOSET <br />FLOOR DRAIN WATER HEATER <br />OTHER gl~ O ¢~- {O t'/~ I WET BAR <br /> <br /> Total#Fixtures 7 x$10.00 =$__ <br />Lawn vacuum breaker / sprinkler systera x $4.50 <br /> <br />WATER LINES <br /> Residential: First l00 fl., Or fraction thereof __ x$20.00 =$__ <br /> Foreaaddnll00RUptoS00feet __ x$15.00 =$__ <br /> Commercial: First 100 fl. Or fi.action thereof x $25.00 = $ <br /> For ea addnl 100 feet x $15.00 = $ <br /> <br /> Y W <br /> Residential: First 100 Pt. Or fi.action thereof x $30.00 = $ <br /> For ea addn1100 tE Up to 500 feet __ x $15.00 <br /> Commercial: First 100 Pt. Or fraction thereof x $30.00 = $ <br /> For ea addnl 100 feet x $15.00 = $ <br /> <br />STORM DRAINS <br /> Residential: First 100 Pt. Or fraction thereof x $30.00 <br /> For ea addn1100 Pt. Up to 500 feet __ x $15.00 <br /> Commercial: For 100 Pt. 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 ~ $5.00 each, sold only to Plumbing contractors) <br /> <br />DWELLING PERMIT LABELS # of Labels <br />(For New Single Family Dwellings Only) <br /> <br />=$ <br />=$ <br />=$ <br />=$ <br /> <br />=$ <br /> <br />N/C <br /> <br />5. FEES <br /> Al. Enter total of fees from Sec. #4 <br /> A2. Add 5% surcharge (,05 x A 1) <br /> <br />B, Enter 25% of line Al for Plan Review <br />(Al + .25), if required $ <br />C. Investigation Fee (if required) $ <br />D. Reinspect ion Fee ($25.00) $ <br /> TOTAL AMOUNT DUE $ <br />Receipt No. <br /> <br />MC 15-45 7/97 <br /> <br /> <br />