Laserfiche WebLink
COMMUNrFY DEVELOPMENT CENTER At ,, ,. ~ I. _../~[~1#'~,.~ '~ <br />FOR CITY V ..,ALIDATJ[ON[ 285 Church St NE- Room 132 PE/RI~,[T~iO~ 7 ~.~ -~f- ,~,, ./~, <br />R~4~ivod by:~[ Salem, OR 97301 ~"J:Ih"/l~ZlS/~,.-0/I/Po,,-"'" £Y~O" ~f <br /> Office' PhoneF~...51458~.? 8'7~Oeam 4'30p. I~uea Dy' (.,,///3a <br /> <br />IPLUMBING PERMIT APPLICATION <br />Pl~t~ complete ~1 &~.gons, I through <br /> <br />1. LOCATION OF IN~rALLATION <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />Board: <br /> <br />Conwac~-'s Board Reg. No. <br /> <br />~omneyman's Plumbers No, <br /> <br />Comractor's Signature: <br /> <br /> FOR OW-NBR INSTALLATIONS <br /> <br />Agent's Signature: <br /> <br />4. FEE SCHEDULE (c0mplet~ and enter to~l in A1 below) <br /> <br /> RBSIDBNTIAL <br /> uss 9F.~rRU~: ~_~; <br /> NEW ~ALTERATION <br /> <br /> No. X Fee = <br />BASE FEB <br /> <br />RBSII~NTIAL (each fixture) <br /> Aut~a Dwelling Piumb/ng Fee __sq. fi. x $.070 <br /> <br /> Single Fmnily or multi-fnmily per <br /> dwelling unit <br /> New construction $I0.00 <br /> Alterations $10.00 <br /> Reconnect $ 5.00 <br /> Reiocnted Structure $ 5.00 <br /> Modular Structure $ 5.00 <br /> <br />Water Lines <br />Fi~t 100 fL or fraction thereof $20.00 <br />For ea. nddnl' 100 ft. (up to <br />maximum orS00 ft.) $15.00 <br /> <br />Sanitary & Storm Lines <br />First 100 fi. or fraction thereof $30.00 <br />For addnl' 100 ft. (up to <br />maximmn orS00 ft.) $15.00 <br /> <br />COMMERCIAL (each fixture) <br /> <br /> New construction $10.00 <br /> Alterations $10.00 <br /> Recounect $10.00 <br /> <br />Water Lines <br />Nirst 100 fi. or fraction ~hexeof $25.00 <br />For ea. addnl' 100 ft. <br /> <br />Sanity & Storm Lines <br /> Flint 100 ft. or fraction lhereof <br /> For addnl' 100 fi. <br /> <br />$15.00 __ <br /> <br />$15.00 <br /> <br />PROTECTIVE BACKFLOW DEVICE <br />Lawnv~cuumbreakcr(sprinidersystcm) ! $4.50 /~,~-'-~ <br />AH others $10.00 <br /> <br /># of Labels NIC <br /> <br />OTHBR (a~ wquir~d by OSPSC <br /> and Build~n~ O~aiaO <br /> <br />DWELLINO I~RMIT LABEL <br /> <br />3. PLAN RBVIBW SBCTION <br /> <br />Marion County does not require a plan review. <br />We will provide plan review service if you complete <br />Section 5B and submit two (2) sets of plans and <br />specifications with this application. <br /> <br />MC 15-45 <br />Rev. 1/96 <br /> <br />Al. Eater total of fee~ from Se~. <br />3,2. Add 5% surcM (.05 x Al) <br /> Subtotal <br /> <br />B. Enter 25% of linc Al for Plan Review <br /> (Al + .25), if required <br />C. Inve~tigalion Fee (if required], <br /> <br /> - - /TOTAL AMOUNT DUE <br /> <br />$ ~0 <br /> <br /> <br />