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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 <br /> Salem, OR 97301 <br /> <br /> 24 hr. Inspection Line 373-4427 <br />Office: Phone 588=514'/ g:00am - 4:30pm <br />FAX: 588-7948 <br /> <br />IPLUMBING PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <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 i80 DAYS. <br /> <br />2A. COHTRACTOR INSTALLATION ONLY <br /> <br />Mailing Address <br /> <br />I Iob No. <br /> <br />Plumbing Board: <br /> <br />2B. FOR OWNER INSTALLATION8 <br /> <br />MailingAddr~ss ~'~<~ ~t'~.~V~_~2,-~ I <br /> <br />Agent's Signature: <br /> <br />Da.to: <br /> <br />Issued by: ~ <br /> <br />4. l~]~lt .~CH~DULll (Comple~ and enter ~o~l io A 1 below) <br /> <br /> RESIDENTIAL El COMMERCIAL [~ <br /> USE OF STRUCTURB: <br /> NEW rq ALTERATION [~ ADDITION [~ RELOCATION <br /> <br /> No. X Fe~ ~ Sum <br />BA~E FEE ~0.O0 <br /> <br />RESIDENTIAL (each fixture) <br /> Aurora Dwelling Plmnlfing Fee <br /> <br />Singl~ Famay or multi-family per <br />dwelling unit <br /> <br />Water Lines <br /> First 100 it. or fraction thereof <br /> FOr ea. addnl' 100 fi. (up to <br /> maximum of 500 fi,) <br /> <br />Sani~ry & Storm Lines <br /> F~rst 100 ft. or fraction ~hcreof <br /> FOr addnl' 100 lt. (upto <br /> maximum of 500 fl.) <br /> <br />COMMERCIAL (each fixturo) <br /> <br /> Fa'st 100 fi. or fraction thereof <br /> FOr ea. addnl' 100 fi. <br /> <br />Sanitary & Storm Lin~ <br /> First 100 fi. or fraction thereof <br /> For addnl' 100 fl. <br /> <br />__sq. ft. x $.070 = <br /> <br />$ 5.00 <br />$ 5.00 <br /> <br />$15.00 <br /> <br />$15.00 <br /> <br />$10.00 <br />$10.00 <br />$10.00 <br /> <br />$2..5,00 <br /> <br />$15.00 -- <br /> <br />$15.00 <br /> <br />OTHER (ss required by OSPSC <br /> and Buildi~g O~c&O <br /> <br />DRrELLING PERMIT LABEl, # of Labels N/C <br /> <br />3. PLANREVIBW 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. Enter totel of fees from Sec. #4 $ <br />Ail. Add 5% su~harge (,05 x Al) $ <br /> Subtotal $ <br /> <br />B. Enter 25% of line Al for Plan Review <br />(Al + .25), if required $__ <br />C. Investigation Fee (iftequirod) $ <br />D, Reinapection Fee ($25.00) $._.~.~ <br /> TOTAL AMOUNT DUB <br />Receipt No. <br /> <br /> <br />