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FOR CITY VALIDATION <br />Re,zeived by: <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br />COMMUNITY DEVELOPMENT CENTf~R <br />285 Church SI NE · Room 132 <br /> Salem, OR 97301 <br /> <br /> 24 Hr lasp~tion Line: 588~7904 <br />Off. e: 588-5147 <br /> FAX: 588-7948 <br /> <br />IPLUMBING ~:RMiT APPLICATION <br />Please complete all Sections, I through <br /> <br />I. LOCATION OF INSTALLATION <br /> <br />Deacrlptio,'~Dir,~dons: <br /> <br /> IZE, glvl]T$ ARE NON-TRANSFERABLE AND EXPIRE IF WORK I$ NOT <br /> STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK I$ SUSPENDED FOR 1 FA) DA¥~. <br /> <br />2A. COlqTRACTOR INSTALLATION OINrLY <br /> <br />Mailing Addmaa <br /> <br />Plural:lng Boa~th <br />Conlractor'8 Boa~] R~g, No, J Job No, <br />loum~maW$ Plumbm No. <br /> <br />PERMIT NO: <br /> <br />Date: <br /> <br />Issued by: <br /> <br /> RESIDENTIAL [] COMMERCIAL [] <br />USE OF STRUCTIJPJ/: <br /> NEW [] ALTERATION Cl ADDITION ~ RELOCATION <br /> <br />BASF., FEE $2O.0O <br /> <br />RESIDENTIAL (ca¢h lixtu~) <br /> Aurora ly~v¢llillg Plumbing l~ec aq, fi. x $-063 = <br /> <br />Single Family or molti-family pet <br />dwolIing unit <br />Neweonatmefion ~ ='~- $I0.00 -- <br />Alteratlora $10.00 <br /> g~conncct $ 5.00 -- <br /> Relocated Strtglure ~ $ $,00 <br /> Modular $tcu¢tu~ $ $.00 <br /> <br />Water Lines <br /> ~lrat 100 R, or f,:actiOn thereof <br /> For ea. ad~fi' 100 R. (up <br /> maximum of S~ ft.) <br /> <br />Snnita~ & Storm ~ncs <br /> <br /> ~r addal' i~ fl, (up to <br /> ~mximum ofS~ tL) <br /> <br />COMMERCI~ (each <br /> Alterations <br /> <br />Water Lines <br /> Fiver 100 ft. or tYaetion thereof <br /> Fot~a. ad4al' 100 R. <br /> <br />t:ir~t It'D fl, or fraction thego£ <br />For addnI' 100 fl, <br /> <br />$20,00 <br />$15.00 <br /> <br />$30.00 <br />$15.00 <br /> <br />$15,00 __ <br /> <br />PROTECTIVE BACKFLOW DIgViCI~ <br /> [.,awn vacumn broaket (aprlnkl¢t system)__ $ 4.50 <br /> Ail othem ~ $10.O0 <br /> <br />OTHER (asrcquj/~dbyOS~SC and Buildiag Ol~ciM) <br /> <br />DWELLING PlgRMIT LABEL <br /> <br />3_ PLANRRVII/W SECTION <br /> <br />Marion County does not reqEire a plan review. <br />We will provide plan review service if you complete <br />Section 58 and submit two (2) sets 0f plans and <br />specifications with this application. <br /> <br />MC' 15.4.5 <br /> <br />5. FEES <br /> Al, Enter total oCt,,es from Sec. <br /> A2, Add 5% surcharge (.05 x Al) <br /> <br />$ubtotal <br /> <br />,eS__ <br /> <br />B. Entel 25% of lin~ A 1 lbr Plan Review <br />(Al 4- ,25), if required <br />C, lnve~tigatio~l Fc~ {if ~quired) <br />D, Rei~pectbn Fe~ ($25.~) $, <br /> <br />Receipt No. ~, TOT~ ~O~ DUg <br /> <br /> <br />