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FOR CITY VALIDATION[ <br />Reezlv~d by: <br />Date: <br /> <br />PLUMBING PERMIT APPLICATION <br />P/ease complete al~ ~ections, 1 througl~ <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY D~VELOPMENT CENTER <br /> 285 Church St NE · Room 132 PERMff NO: <br /> Salem, OR 97301 <br /> Date: <br /> <br /> 24 hr. Inspection Line 373-4427 <br /> Office: Phone 588-5147 8:00am - 4:3~&[n Issued by: <br /> <br /> 4. FBB SCHEDULB (Complcta and cnt~ ~otal in Al below) <br /> <br /> RI~IDENTIAL ~2 COMMBRCIAL C] <br /> US~ OF STRUCTURB: <br /> NEW El ALTERATION El ADDITION El RELOCATION <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT <br />STARTED WITHIN 1~0 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br />Contractor 1 Phone <br /> <br />Mailing Address <br />Plumbing Board: <br /> <br />Contractor's Hoard Reg. No. <br /> <br />Job No. <br /> <br />Journeyman's Plumb~'s No. <br />Contractor's Signature: <br /> <br />2B. FOR OWNBR INSTALLATIONS <br /> <br />3. PL~W S~TION <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 /> No. X F~ = Sum <br />BASE FEE $20.00 <br /> <br />RESIDENTIAL (each fixture) <br /> Aurora Dwelling Plumbix~g Fee __.sq. ft. x $.070 -_ <br /> <br />Single Family or multi-family per <br />dwelling unit <br />N~w con~tmctina $10.00 -- <br />AIt~rationa $10.00 -- <br />Reconnect $ 5.00 <br /> Relocated Structure $ 5.00 -- <br /> Modular Structure $ 5,00 <br /> <br />Water Lines <br />Firat 100 fl. or fraction thereof $20,00 -- <br />For ea. ad&al' 100 fl. (up lo <br />maximtun of S00 ft.) $15.00 -- <br /> <br /> Ftiat lO0 ft. or fraction thereof $30.00 <br /> For addnl' 100 ft. (up to <br /> maximum of 500 fi.) $15.00 <br /> <br />COMMERCIAL (each CLxtur%~ .~ <br /> New construction ~j~'%~C % $10.00 <br /> Alterations t~- ~. $10,00 <br /> Reconnect ~... ~ ~l $10.00 <br /> <br />WaterLines ~'~ <br /> <br /> $15.00 -- <br /> <br />Sanilary & Stom~ Lines ~.~(~) <br /> Firat 100 fl, or fraction thereof <br /> For ad&al' 100 ft. <br /> <br />$.30.00 <br /> <br />$15.00 -- <br /> <br />PROTECTIVE BACK'LOW DEVICE <br />Lawn vacuum breaker (sprinkler system) $ 4.50 <br />Ail others $10.00 -- <br /> <br />OTHER (as required by OSPSC <br /> and Builddag O~$cial) <br /> <br />DWELLING PERMIT LABEL # of Labels N/C <br /> <br />5. FBBS <br /> Al. Enter total of fe.e~ from Sec, g4 <br /> A2, Add 5% surcharge (,05 x Al) <br /> <br />B. Enter 25% of line Al for Plan Review <br />(Al + ,25), if re4uir~d <br />C, Investigation Fcc (if requital) <br />D, Reimpection Fee ($25.00) $.__ <br /> <br /> TOTAL AMOWNT DUE ' <br />Reacipt No. <br /> <br /> <br />