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FOR CITY ~ALIDATION[ <br />Re~=ived by: <br />D~te:. <br /> <br />MARION COUNTY BUILDING INSPHCTION <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 588-5147 8:00am - 4:30pm <br />FAX: 588-7948 <br /> <br />PLUMBING PERMIT APPLICATION <br />Please complete all ,~ctions, I through <br /> <br />I. LOCATION OF INSTALLATION <br /> <br />PERMfI~ ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT <br />STARTED ~ 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />k: <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />C~olra0tor's Board Reg. No. [ ~ob No. ..~ I <br /> i , <br /> <br />2B. FOR OWNBR INSTAL~ATIoNS <br /> <br />Property Owner (plea~ pri=) <br /> <br />Mailing Addr~s [ Fnone <br /> <br />City/S~te~ip <br /> <br />Owner's $ignn(m'e: <br /> <br />Ag~nt'a Si~atur~: <br /> <br />3. PLANRBVIBW 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 />spec~ficauons wtth this applu:at~on. <br /> <br />MC 15-45 <br /> <br />Da~e: <br /> <br />Issued by: <br /> <br />4. l~E 8CH~ULB (Complet~ and en~e~ total in A1 below) <br /> <br /> RESlDI~NTIAL Q CO~CIAL Q <br />USB OF STRUCTURB: <br />NEW ~ ALTERATION m ADDITION m RELOCATION <br /> <br /> BA~E FBE <br /> <br />"-RESIDBNTIAL (each <br /> Au~ra Dwellh~ Plumbing Fee <br /> <br /> Single Fnmily or multi-fnmily per <br /> dwelling unit <br /> <br /> Alte~atlom <br /> <br /> For ea. nddal' 100 ft. (up to <br />~ maximum of 500 ft.) <br /> <br /> For nddnl' 100 ft. (up to <br /> maximum of 500 ft.) <br /> <br /> COMMERCIAL (each fixing) <br /> FOr ea. addnl' 100fl. <br /> <br />SaniUu~ & S~,~n Lines <br /> ~ 100 fL or fraction the~of <br /> For addnl' 100 fl. <br /> <br />PROTECTIVE BACKiFLOW DEVICE <br /> Lawn v~cuum breske~ (sprinkler sys~m)__ <br /> All othcrs <br /> <br />OTHBR (ts t~quimdbyOSPSC <br /> and Building O~iciaO <br /> <br />No. X Fee = 8am <br /> <br />__~. fi. x $.070 =__ <br /> <br />10.00 -- <br />$10.00 -- <br /> S.~O <br /> 5.OO <br /> 5.00 -- <br /> <br />$20.00 -- <br />$15.00 -- <br /> <br />$10.00 <br />$10.00 <br />$10.00 <br /> <br />~25~0 <br />$15.00 <br /> <br />$30.00 <br />$15.00 <br /> <br />$4.50 <br />$10.00 <br /> <br />DWELLING PERMIT LABEL # of Labels N/C <br /> <br />5. FEE8 Al. Emer total of fees from Se~. ~4 <br /> A2. Add 5% surcharge (.05 x Al) <br /> <br />~ubtotal <br /> <br />B. Kuter25% oflJneA! for Plan Review <br />(Al + .25), i~required $ <br />C. Investigation FOe (if required) <br />D. Reinspection Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUE $. <br />Receipt No. -- <br /> <br /> <br />