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MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> / <br />FOR CITY VALIDATION] 285 Church St NE. Room 132 PERIdff NO: <br />Rsceived by:. Salem, OR 97301 Date: <br />Date: 24 hr. Inspection Line 3734427 <br /> Office: Phone 588-5147 8:00am - 4:30pm [~$Ll~ by: <br /> FAX: 588-7948 <br /> <br />PLUMBING PERMIT APPLICATION I <br /> complete ail o~uu.o°~°:~-% I muuu.'~r---~ 5I 4. FtiE SCH~I)ULE (Complete and ent~ total in Al t~low) ~.~ <br />Pleaso <br /> <br /> RESIDENTIAL ~ COMMIlRCIAL <br /> 1. LO12ATION OF INSTALLATION USE OF STRUCTURE: <br /> NEW ~ ALTERATION r~ ADDITION <br /> <br /> P~o~,ow~, 1~ d'lu.,~.~hr~a Pho.~'/qq--~C~t ) RESIDENTIAL (eachExture) <br /> <br /> ~ /n ' · Aurora Dwclbng Plumbing Fee __.sq. fl. x $.070 = <br /> Cr0ssStr~etJDirections: ~'N~,~ ~ ~t~C~- SioglcFamilyormulti-familyper <br /> JobDeseriptinn: PX. LIa~ ~/..~ ~ ~ dwelling unit <br /> . . New construction $10.00 -- <br /> Alterations $10.00 <br />I PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT Reconnect $ 5.00 -- <br /> STARTEDWlTHIN 180DAY$OFISSUANCEORIF RelocatedStmcture $ 5.00 -- <br /> WORK IS SUSPENDED FOR 180 DAYS. Modular Structure $ 5.00 -- <br /> <br /> Water Lioe~ <br /> 2A. 12 ONTRACTOR INSTALLATION ONLY F~t 100 fi. or fraction thereof <br /> For ea. addnl' 100 ft, (up to <br /> Contracto~/~_~l.[k.4_L~./~ t0~Xh6[ [Phone..~l.ll?~- maXUnumofS00ft.) $15.00__ <br /> <br /> Sanitary & Storm Lines <br /> MailingAddresa~l--~ ,~_~ ~C~CR ~ First 100ft. orfraetionther~oC $30.00 -- <br /> ...... For addnl' 100 ft. (up to <br /> ~ 1~(N ~'~ maximum of 500 ft,) $15.00 <br /> Plumbing <br /> Board: <br /> <br /> New construction $10.00 -- <br /> Jouraeyman's .umbers No. } ~--~,~ Alterations $10.00 -- <br /> Reconnect $10.00 <br /> <br /> Fit'at 100 ft. or fraction thereof $25.00 <br /> For ea. addnl' 100 ft. <br /> 211. FOR OWNER INSTALLATIONS $15.00 -- <br /> Sanitary & Storm Lines <br /> Prope~y Ownc: (pleaseprinO First 100 fl. or fraction thereof $30.00 -- <br /> For addnl' 100 ft. <br /> <br /> Mailing Addr~a [ Phone <br /> $15.00__ <br /> <br /> PROTECTIVE BACKFLOW DEVICE <br /> City/State/Zip Lawn vacuum breaker (sprinkler ayatem) $ 4.50 -- <br /> All others $10.00 <br /> Owner's Signature: OTHER (as required by 05P$C <br /> Agent's Signature: and Euil~ng Ol~et~l) <br /> <br /> DWELLING PERMIT LABEL # of Labeh N/C <br /> <br />3. PLAN RliVlIIW S]iCTION <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 />5. FEES <br />A 1. Enter total of fe~ from S~o.//4 $...~ <br />A2. Add5%surcharge(.O5xA1) ,Subtotal ~ <br />B. Enter 25% of line Al for Plan Review <br />(Al + .25), if required $__ <br />C. Investigation Fee (if required) $__ <br />D. Reirmpection Fee ($25.00) $__ <br /> <br /> · o, otnvrmm s <br /> Receipt No. <br /> <br /> <br />