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FOR CITY VALIDATION[ <br /> <br /> 285 Church St NE · Room 132 <br /> Salem OR 97301 <br /> u~e: <br /> <br /> 24 hr. Inspection Line 37~427 IS~ U~UUNTy <br /> O~ce: Phone 588-5147 8:00am - 4:30pm <br /> r~: sss-7948 1~SPECTION <br /> <br />IPLUMBING PERMIT APPLICATION <br />Please complete all ~ections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />l~cfipfion/Directiom: <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT <br />STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />Mailiag Addr~s <br /> <br />Plumbing B~d: <br /> <br />Contractor's Board Reg. No. <br /> <br />I Job No. <br /> <br />Journeyman's Plumbers No. <br /> <br />Contcactor's Signature: <br /> <br />2B. FOR OWNBR INSTALLATIONS <br /> <br />4. FBE $CltH. DULIt (Complete and enter total ia A1 below) <br /> RB$1DBI~ITIAL ~ COMMERCIAL <br /> USE OF STRUCTURB: ,, .~ <br /> NEW rn ALTERATION la/ADDITION I~][[~I~LOCATION <br /> <br /> No. X Fe~ = ~um <br />.BABE FEB $20,00 <br /> <br />RESIDEIqTIAL (each frxmre) <br /> Autor~ Dwelling Plumbing Fee sq. fl. x $,070 = <br /> <br />Single Family or multi-family per <br />dwelling unit <br />New construction $10.00 -- <br />Alt~ratiom $10.00 -- <br />Reconn*ct $ 5,00 -- <br /> Relocated Structure $ 5.00 <br /> Modular Structure $ 5.00 -- <br /> <br />Fieat 100 fi. or fraction thereof $20.00 <br />For ea. addul' I00 ft. (up to <br />maxanmn of 500 ft,) $15.00 <br /> <br />maximum of 500 ft.) $15.00 -- <br /> <br />WaterLines <br />Fimt 100fl. orfractionthereof $25.00 -- <br />For~.addnl' 100fl. <br /> $15.00 <br /> <br />Sanilary & Storm Lines <br />Fimt 1~O ft. or fraetlon thereof $~0.00 -- <br />For addnl' 100 fl. <br /> $15.00 -- <br /> <br />PROTECTIVE BACKFLOW DEVICE <br /> Lawn vacuum breaker (spriaki~r system) . <br /> All other~ <br /> <br />/ $ 4.50 <br /> $10.00 -- <br /> <br />OTHER (ss tvquired by OSPSC <br /> sod Building 01NciM) <br /> <br />DWELLING PER/vi]IT LABEL //of Lal~ls <br /> <br />NIC <br /> <br />3. PLAN RBVIBW 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 />MC 15-45 <br />Rev. 1/96 <br /> <br />5. FBBS <br /> Al. Enter tolaloffees from Sec.//4 <br /> 32. Add 5% surcharge (.05 x Al) <br /> ~btotal <br /> <br /> (^1 + ,25), if required <br /> C. Investigetion Fee (if required) <br /> D. Reimpeefion Fee ($25.00) <br /> <br /> ANIOUNT <br /> DUB <br /> <br /> <br />