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I' FOR CITY VALIDATIONI <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER PI~RMIT NO: <br /> 285 Church St NE · Room 132 <br /> Salem, OR 97301 <br /> <br />24 Hr Inq~x:t~n Lin~; 588-7904 <br />OiTt~ 5BB-5147 g:00a_m.-4:30pJu. <br />FAX: 588-7948 <br /> <br />PLUMBING PERMIT APPLICATION <br />Please complete all Sections, I through <br /> <br />I. LOCATION OF iNSTALLATION <br /> <br />IX.~dpfiontDir~fi~: <br /> <br /> STARTF~D WITHIN 180 DAYS OF iSSUANCE OR IF , I <br /> WORK I$ SUSPENDED FOR IS0 DAYS. <br /> <br />2A. CONTRACTOR IlqSTALLATION ONLY <br /> <br />Mailing Addteaa , <br /> <br />Job No, <br /> <br />ConIractor's Board P~g. No, <br /> <br />No. <br /> <br />3, PLANREVIIqW 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 />MU 15.45 <br /> <br />Date: <br /> <br />Issued by: <br /> <br />4. FEE $CHr~DUL]~ (Complete and eater to~l in A t below) <br /> <br /> RESIDENTIAL C~ COMMERCIAL <br /> USE OF STRUCTURE: <br /> NEW (~ ALTERATION U] ADDITION ~ Ri~OCATION <br /> <br /> Ne, X p~ = aura <br />BASE FEE <br /> <br />Single Family or multi-funnily per <br /> <br /> N~ ~nsU~tion ~ $10.~ <br /> <br /> Modular g~lug $ 5,~ <br /> <br /> F~t 1~ R~ or fmotlon ~e~f $20.~ <br /> For em ad~l' 1~ ~. (up to <br /> <br /> ~r ad~l' 1~ R. (up to <br /> m~im~ ofS~ R.) $15.00 <br /> <br /> Alt~afions $10.~ <br /> <br /> ~r ea. addal' 100 ~. <br /> <br /> $30.~ <br /> <br /> $ <br /> $10.00 <br /> <br />PROTECTIVE BACKFLOW DI/VICE <br /> Lawn yucatan b~al{¢r (sprinkler ~ysteal) <br /> All others <br /> <br />OTHER Os t~quirvd by OSP~. <br /> and Building Oll~eiaO <br /> <br />DWELLING PI~RMIT LABItL <br /> <br />-- sq, ft, x $,065 = <br /> <br />g of Labels ~LC-- <br /> <br />5. FEES <br />Al, Enter total of foes from S,~, #4 <br />A~, Add 5% aurohatg~ (.OS x AD $., <br /> Subtotal $ <br /> <br /> B. ~tet 25% of line A 1 for Plan R~vlow <br /> (Al + .25), if ~quired $ <br /> C, Investigatbn Fe~ (if requital) $ <br /> D, R¢impe0tion Fee ($25.~) $ <br /> <br /> TOT~ ~0~ DUB <br /> Receipt No, ~,,, <br /> <br /> <br />