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FOR CITY VALIDATION <br />Received By: <br /> <br />Date: <br /> <br /> MARION COUNTY <br />BUILDING INSPECTION DIVISION <br />3150 Lanca~er Dr. NE - Suite C <br /> Salon, Oregon 97305-1398 <br /> <br /> 24 HR Inspection Line 37:]-4427 <br />Office: phone 588-5147 8:00am - 4:30pm <br />FAX S88-7948 <br /> <br /> PLUMBING PERMIT APPLICATION <br />Please complete all Sectt'ons, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br /> 1 1o1 1-191- Iol-I -Iv Iol ; <br /> CROSS STREET/DIRECTIONS ~ <br /> <br /> pRO.CT DESC?a rION <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT 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 Contmcwr <br /> <br />Mailing <br />Address <br /> <br />PLUMBING BOARD NO. <br /> <br />CONTRACTORS BOAKD <br />REGISTRATION NO. <br /> <br />JOURNEYMA~S <br />PLUMBERS NO. <br /> <br />CONTRACTOR'S SIGNATURE <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br />Property Owner (please print} <br /> <br />Mailing Address <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 />PERMIT NO: <br />Date: <br /> <br />Issued by: <br /> <br />4. FEE SCHEDULE (compim ~d ~ total in 5-Al below) <br /> <br />RESIDENTIAL [~ COMMERCIAL ~ USE: <br /> ~w ~ ~o~ ~ ~nm~ ~ ~A~ <br /> <br />BASE ~E ~se~ on MI ~plic~ons $20.~ <br /> (Exc~tinn: W~/~ L~e A~lic~ w/no <br /> <br />AREA DRAiN INTERCEPTOR <br />BACKFLOW PREV DEVICE LAUNDRy TUB <br />BATHTUB RECEPTOR <br />BIDET SHOWER <br />CATCH BASiN SFNK <br />CLOTHES WASHER TROUGH DRAIN <br />DENTAL UNIT TUB/SHOWER <br />CUSPIDOR URINAL <br />DKIN~ING FOUNTAIN WATER CLOSET <br />FLOOR DRAIN WATER HEATER <br />OTHER ~ BAR <br /> <br /> Total # Fixturesx $10.00 = $ <br />Lawn vacuum breaker / sprinkler system __ x $4.50 -- $ <br /> <br /> Residential: First 100 f., Or fraction thereof -- x$20.00 =$ <br /> Foreaaddnll00flUptoS00 feet __ 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 /> Residential: First 100f, or fraction thereof x$30.00 =$ <br /> Foreaaddnll00 ft. UptoS00fe~ __ x$15.00 =$ <br /> Commercial: First 100 f. Or fraction thereof x $30.00 -- $ <br /> Foreaaddnl 100 f'eet x$15.00 =$ <br /> <br />STORM DRAINS <br /> Residential: First 100f. orffactionthereof x$30.00 =$ <br /> For ea addn1100 ff. Up tu 500 feet x $15.00 = $ <br /> Commercial: For 100 ff. Or fraction thereof x $30.00 = $ <br /> For ca addn1100 feet x $15.00 = $ <br /> <br />MINOR INSTALLATION LABELS x $50.00 = $ <br />(Pack of 10 labels ~ $5.00 *ach. sold only to Plumbing contr~tors) <br /> <br />~,~,~g,~~ # of Labels N/C <br />(For New Single Family Dwellings Only) <br /> <br />5. FEES <br /> A I. Enter wtal of fees from Sec. #4 $ <br /> <br />B. Enter 25% of linc A1 for Pla~ R~vlew <br /> (At + .25), if ~equi~4 <br />C. Investigation Fee (if required) <br />D. Relnspe~tlon Fee ($25.00) <br /> <br />ReceiptNo. <br /> <br />Subtotal $ <br /> <br />TOTAL AMOUNT DUE <br /> <br />MC 15-45 7/97 <br /> <br /> <br />