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IFOR CITY VALIDATION[ <br /> Received by:. ] <br /> Date: <br /> <br />COMMUNITY DEVELOPMENT CENTER <br />285 Church St NE · Room 132 Pi/lIMIT NO: <br />Salem, OR 97301 <br /> Dato: <br /> <br /> 24 hr. Inspection Line 373~4427 <br /> Offlee: Phone ~88-~147 8:00am - 4:30pm [88U~[ Dy: <br /> FAX: 588-7948 <br /> <br />PLUMBING PERMIT APPLICATION <br />Please complete all Sections, I through <br /> <br />1. LOCATION OF HqSTALLATION <br /> <br />Pl~.b~rs ARE NON-TRANSFERABLE AND EXPIRE 1~ WORK IS NOT J <br /> STAk'I~D WITHIN 1~0 DAYS OF I5$UA~CI~ OR IF <br /> WORK IS SUSIq~ND~D FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />2B. FOR OWNHR INSTA]J.&TIONS <br /> <br />Agent's Sigmtu~: <br /> <br />4. FBla 8CHI]DULE (Complelo ~nd enter tolnl in Al bobw) <br /> <br /> RI~SWlmTIAI.,~' COMI~ImC~L ~ <br /> <br /> NEW~ AbTERATION O .,~DmON 0 RELOCATION O <br /> <br />BA.~ FEE <br /> <br />~NTIAL (~aeh <br />Amora ~1~ <br /> <br />S~gle ~ily ~ m~t~ily <br />~elli~ ~it <br />N~ ~n $10.~ <br />A~m $10.~ <br />Re~ct $ 5~ <br />Re~a~ S~ $ 5.~ <br />Mo~l~ ~c~ $ 5~ <br /> <br /> F~ 1~ fl. ~c~ ~ ~.~ <br /> ~r ~. a~l' 1~ ~ (up ~ <br /> ~ of S~ fl0 $15.~ -- <br /> <br />~&5~ L~ <br /> <br /> ~ra~' l~ (~ m <br /> ~ of ~ R.) $15.~ <br /> <br />~M~RCI~ (~eh f~) <br /> <br /> N~ ~n <br /> Al~om $10~ <br /> R~t $10.~ <br /> <br />Water Line~ <br /> First 100 fl. or fractio~ the~of <br /> Forea. nddnl' 100 ft. <br /> <br />$15.00 -- <br /> <br />SanlU~y & $~oon Line~ <br /> Fimt 100 fL er fraction ~heeeof <br /> For addnl' 100 iL <br /> <br />$15.00 <br /> <br />PROTBCTIVg BACKFLOW DEVICB <br />Lawn vaouum In.k= (sprinkl~ system) $ 4.30 <br />All othem $10.00 -- <br /> <br />OTHER (ss roquited by O~P~C <br /> and Build~g O~elaO <br /> <br />DWELLINO PERMrr LABEL # of Labeh <br /> <br />3. PLANRE¥1~W' 8BCTION <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 /> <br />