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FOR CITY VALIDATION <br />Received By: I <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 Inspeefion Line 373-4427 <br />Office: phone 5885147 8:00am - 4:30pm <br />FAX 588-7948 <br /> <br />PERMIT NO: <br />Date: <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 /> 1 l l l-131 l l-I <br /> <br /> PRO.CT DESC~PTION <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 />Plumbing Contractor <br /> <br />Mailing <br />Address Ci,ty <br /> <br />CONTRACTOR'S SIGNATURE <br /> <br />2B. FOR OWNER INSTALLATIONS <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 &plans and <br />specifications with this application. <br /> <br />4. FEE SCHEDy. L~/(Complete and enter !ctal in 5-Al helow) <br />RESIDEI'~fI~ COMMERCIAL [~ USE:__ <br /> NEW ~r ALTERATION f'l ADDITION O RELOCATION <br /> <br />BASE FEE Assessed on all applications $20.00 <br /> (Exception: Water/Sewer Line Applications w/no fmtures) <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 DRAIN <br />OTHER <br /> <br />OTY OTY <br />INTERCEPTOR <br />LAUNDRY TUB <br />RECEPTOR <br />SHOWER <br /> SINK <br /> TROUGH DRAIN <br /> TUB/SHOWER <br /> URINAL <br /> WATER CLOSET <br /> WATER HEATER <br /> WET BAR <br /> <br /> Total g Fixtu~s x $10.00 = $ <br />Lawn vacuum breaker / sprinkler system __ x $4.50 = $__ <br /> <br /> Residential: First 1 O0 iL, Or fraction thereof /' x $20.00 = $__ <br /> For ea addn1100 ft Up to 500 fe~'t -- x $15.00 <br /> Commercial: First 100 iL Or fraction thereof x $25.00 = $ <br /> For ea addnl 100 feet x $15,00 = $ <br /> <br /> Residential: First 100 iL Or fraction thereof ! x $30.00 = $__ <br /> Foreaaddnl 100 iL Up m 500 feet -- x$15,00 <br /> Commercial: First 100 iL Or fi.action thereof x $30.00 = $ <br /> For ea addnl 100 feet x $15.00 = $ <br /> <br />STORM DRAINS <br /> Residential: First 100 fl. Or fraction thereof x $30.00 <br /> For ea addal 100 R. Up m 500 feet __ x $15.00 <br /> Commercial: For 100 f~. Or fi.action thereof x $30.00 <br /> For ea addn1100 feet x $15.00 <br /> <br />MINOR INSTALLATION LABELS x $50.00 <br />(Pack of 10 labels ~ $5.00 each, sold only to Plumbing contractors) <br /> <br />~ # of Lahels __ <br />(For New Single Family Dwellings Only) <br /> <br />=$ <br />=$ <br />=$ <br />=$ <br /> <br />=$ <br /> <br />N/C <br /> <br />5. FEES <br /> Al. Enter total of fees fi'om Sec. #4 <br /> A2. Add 5% surcharge (.05 x Al) <br /> Subtotal <br /> <br />B. Enter 25% of line A 1 for Plan Review <br /> (Al + .25), if requlred <br />C. Investigation Fee (if required) <br />D. Reinspeetion F~e ($25.00) <br /> <br />Receipt No, <br /> <br />TOTAL AMOUNT DUE <br /> <br />MC 15-45 7/97 <br /> <br /> <br />