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F~)R C~TY VALIDATION <br />Received By: <br /> <br />IDate: <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 <br />Please complete all Sections, 1 through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> TAXACCO TNO' I / 1 I21sI--IoIoIo <br /> <br /> Isl O - I 7la I - o I F* <br /> c~oss SX~E~[~CT10~S <br /> <br />PRO.CT DESC.PTION Odd, <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT ] <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 <br /> <br />PLUMBING BOARD NO. <br /> <br />CONTRACTORS BOARD <br />REGISTRATION NO. <br />JOURNEYMANS <br />PLUMBERS NO. <br /> <br />CONTRACTOR'S SIGNATURE <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br />Mailing Address <br /> <br />Owner's Signature <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: ~--0 2~~ <br />Date: <br /> <br />Issued by: <br /> <br />4. FEE SCHEDULE (Complete and enter total in 5-Al b~low) <br /> <br />RESIDENTIAL ~ COMMERCIAL ['l USE: <br /> <br />BASE FEE Assessed on all 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 ] RECEPTOR <br />BIDET SHOWER I' <br />CATCH BASIN SINK I <br />CLOTHES WASHER ~ TROUGH DRAIN __ <br />DENTAL UNIT TUB/SHOWER <br />CUSPIDOR URINAL <br />DRINKING FOUNTAIN WATER CLOSET I <br />FLOOR DRAIN WATER HEATER [ <br />OTHER WET BAR <br /> <br /> Total # Fixtures ~ x $10.00 <br /> <br /> Lawn v~¢ / sprinkler system x $4.50 <br /> <br /> 00 ii., Or fraction thereof x $20.00 = $ ~ O <br />. ~._.~Foreaaddnl 100 tt Up to 50O feet /~_ x$I5.00 =$ <br /> First I00 ti. Or fraction thereof / \ x $25.00 = $ <br /> For ea addnl 100 feet x $15.00 = $ <br /> <br /> For ea addnl 100 fl. Up to 500 feet <br /> Commercial: First 100 ii. Or fraction thereof <br /> For ea addnl 100 feet <br /> <br />STORM DRAINS <br /> Residential: First 100 ii. Or fraction thereof x $30.00 = $ <br /> For ea addnl 100 ft. Up to 500 feet __ x $15.00 <br /> Commercial: For I00 ii. 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 ~ $5.00 each, sold only to Plumbing contractors) <br /> <br />~ # of Labels N/C <br />(For New Single Family Dwellings Only) <br /> <br />=$ '70 <br /> <br />=$ <br /> <br />_~$3o.oo =$ ~O <br /> $15.00 = $ <br /> x $30.00 = $__ <br /> x $15.00 = $ <br /> <br />5. FEES <br /> Al. Enter total of fees from Sec. #4 <br /> A2. Add 5% surchatga (.05 x Al) <br /> <br />B. Enter 25% of line A I for Plan Review <br /> (At + .25), if required <br />C. Investigation Fee (if requlred) <br />D. Reinspeetion Fee ($25.00) <br /> <br />Receipt No. <br /> <br />Subto~[ <br /> <br />TOTAL AMOUNT DUE <br /> <br />/,20 <br /> <br />MC 15-45 7/97 <br /> <br /> <br />