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. MARION COUNTY BUILDING INSPECTION <br />"~- '~'- COMMUNITY DEVELOPMENT CENTER ...~ <br />-- -- 285 Church St NE · Room 132 ~ll~"~ <br />Rec~ivexl by' Salem, OR 97301 ~.f,,;~ -- <br /> Date: ' ~ ' <br /> ~ 24 hr. Inspection Line 373-4427 <br /> Office: Phone 588-5147 8:00am - 4:30pm 188U~0 <br /> FAX: 588-7948 ~A[~[O[~ <br /> PLUMBING PERMIT APPLICATION oui~ullvG <br /> Please complete all Sections, I through 5 4. FEB SCI-IEDUI~ (Complete <br /> RESIDENTIAL CI <br /> <br />1. LOCATION OF INSTALLATION <br /> <br /> PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK 1S NOT I <br /> STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />Plumbing Board; <br /> <br />$oumeyman's Plumbers No. ~ 3/0 '~"'P <br /> <br />211. FOR OWNER INSTALLATIONS <br /> <br />Property Owner (p/oaae print) <br />Mailing Address I Phone <br />City/S~ate4Zip <br />Owner's Signature: <br />Agent's Signature: <br /> <br />3. PLAN REVIEW SIICTION <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 ! ~t.../~ / /q~ <br />Rev. 1/96 <br /> <br />USE OF STRUCTURE: <br />NEW {2 ALTERATION D ADDITION/2 RELOCATION <br /> <br /> No. X Fee = Sum <br />BASE FEE $20.00 <br /> <br />RESIDENTIAL (each fixture) <br /> Aurora Dwelling Plumbing Fee __sq. ff. x $.070 - <br /> <br />Single Family or multi-family per <br />dwelling unit <br />New construction $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 />First 100 fL or fraction thereof $20.00 <br />For ea. addnl' 100 fl. (up to <br />maximum of 500 fL) $15.00 -- <br /> <br /> $30,00 <br /> (up to <br /> maximum of 500 ft.) $15,00 -- <br /> <br />COMMERCIAL (each fixture) <br /> <br /> New construction $10.00 -- <br /> Alterations $10,00 -- <br /> Reconnect $10.00 -- <br /> <br />Water Lines <br />First 100 fL or fraction thereof $25 <br />For ea. addnl' 100 fi. <br /> <br />Sanitary & Storm Lines <br /> First 100 fL or fraction thereof <br /> For addnl' 100 fl. <br /> <br />$15,00 <br /> <br />$30.00 <br /> <br />$15.00 -- <br /> <br />PROTECTIVE BACKPLOW DEVICE <br />Lawn vacuum breaker (sprinkler system) $ 4.50 -- <br />All others $10.00 -- <br /> <br />OTHER (~srequiredbyOSPSC <br /> and Bulling Or'claD <br /> <br />DWELLING PERMIT LABEL # of Labels N/C <br /> <br />5. FEES ~.~t~ · O O <br />AL Enter total of fees from Sec. ~4 $ <br />A2. Add5%sureharg~(,05xAl) $ ~t. ~ ~l <br /> Subtotal $__ <br /> <br /> B. Enter 25% of line A 1 for Plan Review <br /> (Al + .25), if required $__ <br /> C. Investigation Fee (if required) $__ <br /> D. Reimpection Fee ($25.00) $__ <br /> <br /> Receipt No. <br /> <br /> <br />