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FOR CITY VALIDATION[ <br />Received by: <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> 285 Church St NE · Room 132 PERMIT NO: <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 Sections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />~ohAd~ IlO ~o. rre~ ~' <br /> <br />Pmpe~ Ow~r To ~,, Ffl~e <br />Demipfio~i~ctiom: <br /> <br />PERM1TS 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 /> <br />l Job No. <br /> <br />2B. FOR OWNBR iNSTALLATIONS <br />Property Owner (pl~ pri~) <br /> <br />Mailin~ Address <br /> <br />City/S~te/Zip <br /> <br />3. PLANRBVIBW 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 />Date: <br /> <br />Issued by': <br /> <br />4. FEE $CHtiDUL~ (Complete and e~e~ to~alinAl below) <br /> RE$1DBNTIAL ~/ COMMI/RCIAL <br /> USB OF STRUCTURB: <br /> NEW {2 ALTERATION C2 ADDITION m RELOCATION <br /> <br />BA~E FEE $20.~ <br /> <br />RESIDENTIAL (e~ch fmtore) <br /> Aurora Dwelling plumbing Fee __sq. fi. x $.070 <br /> <br />Single Family or multi-family per <br />dwelling unit <br />N~v construction $10.00 <br />Alteration~ -~ $10.00 <br />Reconnect $ 5.00 <br />Rclocal~d Stracmre $ 5.00 <br />Modular SIn~ture $ 5.00 <br /> <br />Water Line~ <br />Fimt lO0 fL or fraction thereof $20.00 <br />FOr ea. addul' 100 ft. (up to <br />maximum of 500 ft.) $15.00 <br /> <br />sanaa~ & Storm Lines <br />Firat 100 ft. or fraction thereof $30.00 <br />For addnl' 100 fL (up to <br />maximum of 500 ft.) $15.00 <br /> <br />COMIVmRCIAL (~¢h fixtoro) <br /> <br /> New cons~¢fon $10.00 <br /> Alterations $10.00 <br /> Reconnect $10.00 <br /> <br />Water Lines <br />First 100 fl. or fraction the~of $2~.00 <br />For ea. adduP 100 fi. <br /> $15.00 <br /> <br />Saints~ & Storm lines <br /> First 100 ft. or fraction thereof <br /> For addul' 100 fi. <br /> <br />$30.00 <br /> <br />$15.00 -- <br /> <br />PROTECTIVE BACKFLOW DE~ICE <br />Lawn vaeumn breaker (sprinkler systom) $ 4.50 <br />AIl others $10.00 -- <br /> <br />OTHER (as requir~d by OSP~C <br /> aad Builddag O~cial) <br /> <br />DWELL1NO PERM1T LABEL # of Lab~h NIC <br /> <br />5. FI~S <br /> Al. Enter totalof f~ from So~, ~4 <br /> A2. Add 5% surcharge (.05 x Al) <br /> Subtotal <br /> <br /> B. Eater25% oflingA1 forPlanReview <br /> (Al + .25), if required <br /> C, Inves tigalion Fee (if requir~l) <br /> D. Reinspeetion FOe ($25.00)TOTAL AMOUNT DUE <br /> <br /> Receipt No. <br /> <br /> <br />