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IFOR CITY VALIDATION[ <br /> Received by: <br /> Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> 285 Church St NE · Room 132 PERMIT NO: <br /> Salem. OR 97301 <br /> <br />24 Hr In~po*tion Lh~a 588-7904 <br />Ofl%~: 511115147 8:OOa.m--4:3Op.m. <br />FAX: 588-7948 <br /> <br />PLUMBING PERMIT APPLICATION <br /> Please complete all Sections, I through 5 <br /> <br />1- LOCATIOI,I OF INSTALLATION <br /> <br />,,,De~edption/Direeti~ s: <br /> <br /> PERMITg AI~ NON-TRANSFEP.~IBI.~ AND EXPIRE IF WORK I$ NOT <br /> STARTED wrI141N 180 D&YS OF ISSUANCE OR IF <br /> WORK IS gUSPENDED FOP~ lg0 DAYS. ,, <br /> <br /> CONTRACTOR INSTALLATION <br /> <br />COlllraetor ] Phon~ <br /> <br />_Mailing Address <br /> <br /> Plumbing Board: <br /> Contta*ter't~ Board Reg. NO, '1r Job No. <br /> loutne~yn~affa I~lumbem No. <br /> Conlractor'a Signatu~: <br /> <br />2tl. FOR OWNER INSTALLATIONS <br />Prop~ly Owner (please print) <br /> <br />Mailing Addre.qs I Phone <br /> <br />City/State/Zip <br /> <br />Date: <br /> <br />Issued by: <br /> <br />4. PE'g, F~2Hr~DIJL]~ (Complete an~l enter ~otel M Al below) <br /> <br /> RES~E~I~ ~ CO~CI~ <br /> US~ OF ~RUCT~: <br /> NEW O AL~TION ~ ~D~ION ~ R~OCATION/O <br /> No. X F~ ~ <br />BASE <br /> FEE <br /> <br />~SlD~I~ (each f~tu~) <br /> A~ra Dwelli~ Plumbi~ ~ae ~ gq, fi, x $.065 = <br /> <br />Single Family or multi-family <br />dwelling unit <br /> <br /> Alt~tatiom <br /> <br /> Modular Steuctttr~ <br /> <br />Water Lines <br /> Fimt l~ fl. Or fraction <br /> <br /> m~immn ofS~ ~.) <br /> <br />Sanim~ & Sto~ L/nm <br /> F~t 1~ fi. or fraotbn ~emf <br /> ~r adap 100 t. (up ~ <br /> m=imum of S~ <br /> <br />COMM~RCI~ (~¢h f~lure) <br /> <br /> Ag~rafmm <br /> <br />Water Lines <br /> <br /> For e~, addal' 1~ ~. (up <br /> mx~um of 5~ ~.) <br /> <br /> For ad~l' 100 fi. (llp to <br /> <br />10.00 -- <br />$10.00 -- <br />5,00 -- <br /> 5.00 <br /> 5.00 __ <br /> <br /> $20.00 <br /> $15.00 <br /> <br />.... ~ $30,00 <br /> <br />$15.00 -- <br /> <br />$10.00 -- <br />$10.00 .... <br />$10.00 ,, <br /> <br />$25.00 ...... <br /> <br />$15.00 __ <br /> <br />$30,00 __ <br />$15,00 ...... <br /> <br />$ 4,5o __ <br />$10.00 <br /> <br />OTHER (a~ceqoiredbyOSPSC <br /> aad Builddng OticiaO <br /> <br />DWELLING PERMIT LABEL <br /> <br /># of Labeb <br /> <br />3. PLAN KEVIIIW SECTION <br /> <br />Marion County doe~ 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 15-4.~ <br />P~¥. IW94 <br /> <br />Al, Enter lotel oFfe¢~ from Sec, <br />A2, Add 5% surcharge (.05 x A 1) <br /> <br />b'ubtotal <br /> <br />B, Enter 25% of lin~ A 1 Ibr Plan Review <br />(A 1 + ,25), if r0quired $ <br />C, Investigation F~e (if requii~d) $ __ <br />D, Reinspection Fee ($25.00) $ <br /> <br /> TOTAL AMOUNT DUE $ <br /> <br /> <br />