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FOR CIT,.Y. MAI~DATION I <br /> <br /> PLUMBING PERMIT APPLICATION <br />Please complete ali Sections, I through 5 <br /> <br /> MARION COUNTY / <br />BUILDING INSPECTION DI~lil~llll-i~ PERMIT NO: <br /> 3150 Lancaster Dr. NE - Suite <br /> Salem, Oregon 97305-1398 I~-- Date: <br /> <br /> 24 HR Inspection Line 373-4~ ~l~ <br /> Office: phone 588-5147 8:00am J'~Wpnr' Issued by: <br /> FAX 588-7948 <br /> MARION COUNTY <br /> rani niNE, INSPECTION <br /> <br />1. LOCATION OF INSTALLATION <br /> TAX ACCOUNT NO. IoI *l ol l--IOIoIo <br /> <br /> C~OSS ST~ET~I~ONS <br /> <br />PROYECT DESCRIPTION <br /> <br />PEPAMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT I <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 Cit~ <br /> ;:7 <br /> <br /> CONTRACTOR'S SIGNATURE <br /> <br />2B. FOR OWNER INSTALLATIONS <br />Pr°Pefi~Owner(pleasepri~t)G~ / ~'~ <br />Ma.m A~dres~ p O 13 ,~ ~ ..3 5~ <br /> City, State, Zip ~/~/~. ~.. 9~'OO ~./ <br /> <br /> Agent's Si~amre ~ <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 />,~. F[~'~IEDULE (Complete and enter total in 5-Al b~low) <br />RESIDENTIAL ~'~ COMMERCIAL 0 USE: <br /> <br /> NEW ~ ~TE~TION ~ ~DI~ON ~ ~A~ON <br /> <br /> BASE FEE Assess~ on all applications <br /> (Exception: Water/Sewer Line Applications w/no <br /> <br />FIXTURES OTY OTY <br />AREA DRAIN INTERCEPTOR <br />BACKFLOW PREV DEVICE LAUNDRY TUB <br />BATHTUB RECEPTOR <br />BIDET SHOWER <br />CATCH BASIN SINK <br />CLOTHES WASHER TROUGH DRAIN <br />DENTAL UNIT TUB/SHOWER <br />CUSPIDOR URINAL <br />DRINKING FOUNTAIN WATER CLOSET <br />FLOOR DRAIN WATER HEATER <br />OTHER WET BAR <br /> Total#Fixtures ,~ x $10.00 <br /> x $4.50 <br /> <br />Lawn vacuum breaker / sprinkler system <br /> <br />WATER LINES <br /> Residential: FirstlOOR.,Orfmctionthereof ~ x$20.00 =$ <br /> ForeaaddnllOOflUptoS00 feet __ x$15.00 =$ <br /> Commercia[: First 100 ti. Or fraction thereof x $25.00 = $ <br /> For ea addnl 100 feet x $15.00 = <br /> <br /> Residential: First I00 tL Or fi.action thereof / x $30.00 = $ <br /> Foreaaddnl IO0~.UptoS00feet __ x$15.00 =$ <br /> Commercial: First 100 B. Or fraction thereof x $30.00 = <br /> For ea addnl I00 feet x $15.00 = $ <br /> <br />STORM DRAINS <br /> Residential: First 100 fl. Or fi.action thereof x $30.00 = $ <br /> Foreaaddnl 100fi. Up to S00 feet -- x$15.00 =$ <br /> Commemiah For 100 fr. Or fraction thereof x $30.00 = $ <br /> Foreaaddnl 100 f~t 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 Labels N/C <br />(For New Single Family Dwellings Only) <br /> <br />5. FEES <br /> Al. Enter total of fees from 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 required <br />C. Investigation Fee (if required) <br />D. Reinspection Fee ($25.00) <br /> <br />Receipt No. <br /> <br />TOTAL AMOUNT DUE <br /> <br />$ <br />$ <br /> <br /> <br />