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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 Pg:RMff NO: <br /> Salem, OR 97301 <br /> Date: <br /> <br /> 24 hr. Inspection Line 373-4427 <br /> Office: Phone 588-5147 8:00am - 4:30pm Issuod by: <br /> FAX: 588-7948 <br /> <br />PLUMBING PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br />I.~OCATION OF INSTALLATION <br /> <br />I~cripfi~Dir~ti~: <br /> <br />ywca'rs ; O.-XnANS RAR& wok Is NOT <br /> <br />STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br />WORK 1S SUSPENDED FOR 180 DAYS. <br /> <br />2A, CONTRACTOR IN//TALLATION ONLY <br /> <br />. OR OWNltR INSTALLATIONS <br /> Property Own~ (ple~so prim) ~ <br /> <br />Agent's Signature: <br /> <br />4. ~7]~E SCH~DULII (Complete and eme~ wtal in A1 below) <br /> <br /> RBSlDBHTIAL [~ COIViMBRCIAL El <br /> USE OF STRUCTU~RE: <br /> NEW El ALTERATION El ADDITION El RELOCATION El <br /> <br />BASH FEE $20.00 <br /> <br />RESIDENTIAL (each ftxtur~) <br /> Amora Dwelling Plumbing Fee __.sq. <br /> <br />Single Family or multi-family per <br />dwelling unit <br />New con,traction $10.00 <br />Alterations $10.00 <br />Reconnect $ 5.00 <br />Relocated Structure $ 5.00 <br />Modular Structure $ 5.00 <br /> <br />Water Lines <br /> <br /> For e~. addnl' 100 IL (up to <br /> n~ximum of 500 ft.) $15.00 <br /> <br />Sanitary & Stuml Lin~l <br />First 100 fl. or fraction thereof <br />For addnl' 100 ft. (up to <br />n~ximum of 500 fl.) $15.00 <br /> <br />{2OMI'dI~R~LM~ (each <br /> <br /> N~w con~tmction $10.00 <br /> Altemtinm $10.00 <br /> R~:onnect $10.00 <br /> <br />Water Lines <br /> Fhst 100 ft. or fraction the~of <br /> For ea. addal' 100 fc <br /> <br />$25.00 -- <br />$15.00 -- <br /> <br />$30.00 -- <br />$15.00 <br /> <br />OTHER (as required by OSP~C <br /> and Buil~ag OgiciM) <br /> <br />DWELLING I~RMIT LABEL # of Labels <br /> <br />3. PLANRBVIBW SRCTION <br /> <br />Marion County does not require a plan review. <br />We will provide plan review sen, ice 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 />A2. Add 5% surcharge (.05 x Al) $ <br />~abtotal <br /> <br /> B. Enter 25% of line A1 for Plan Review <br /> (Al + .25), if required $ <br /> C. Investigation Fee (if required) $ <br /> D. Reinap=¢tion Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUB <br /> Receipt No. <br /> <br /> <br />