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FOR CITY VALIDATION <br />R~oivod by: <br />Date: <br /> <br />MARION COUNTY BUILDING I~SPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> 285 Church St NE · Room 132 PERMff NO: <br /> Salem, OR 97301 <br /> Date: <br /> <br />PLUMBING PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />24 hr. Inspection Line 373~4427 <br />Office: Phone 588-5147 8:00am - 4:30pm ISSU~ by: <br /> <br /> 4. F~B SCHEDULE (Cknnplcte nnd enter wtalin Al below) <br /> <br /> USE OF STRUCTURE: - ¢¢ ,,~ <br /> NEW~ ALTERATION I~ ADDITION m RELOCATION <br /> <br />Pf~,MITS ARE NON-TRANSFERABLE AND EXPIRE 1~ WORK IS NOT <br />STARTED WrrHlH 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPI/NDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR IN~'rALLATION OHLY <br /> <br />Plumbing <br />Contractor's Board Reg. No. [ ~ob No, <br />Joumcyman'a Plumber~ No. <br /> <br />2B. FOR O~ INSTALLATIONS <br /> <br />Propeffy Owner Ole~so pri~) <br /> <br />Mating Addr~s I Phone <br />City/State/Zip <br /> <br />3. PLANREVIEW SECTION <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 /> No. X Fee = 8urn <br />BASE FEE <br /> <br />RESIDENTIAL (each fixtore) <br /> Aurora Dwelling Plumbing Fee __sq. fL x $.070 <br /> <br />Single Family or multi-family p~r <br />dwelling unit <br />New const~uctlon $10.00 <br />Alter~ons $10.00 <br />Reconnect $ 5.00 <br />Relocated Strucmro $ 5.00 <br />Modular S~ructur¢ $ 5.00 <br /> <br />Watar Linea <br />First I00 ft. or fraction thereof $20.00 <br />For ca. addul' 100 fL (up to <br />maximum orS00 ftc) $15.00 <br /> <br />Sanitary & Storm Lines <br />First 100 fL or fraction thereof $30.00 <br />For addul' 100 fL (up to <br />maximum of 500 fL) $15.00 <br /> <br />COMMERCIAL (each fixture) <br /> <br /> New construction .~ $10.00 <br /> Al~rations $10.00 <br /> Reconnect $10.00 <br /> <br />Water Lines <br />Fitat 100 ft. or fraction thereof $25.00 <br />For ea. addnl' 100 ft. <br /> <br />Saultary & S~-m Lines <br /> First 100 ~ or fi~ction thereof <br /> For addnI' 100 fl. <br /> <br />$15.00 -- <br /> <br />$15.00 -- <br /> <br />PROTECTIVE BACKNLOW DEVICE <br />Lawn vacuum b~eaker (sprinkler system) $ 4.50 -- <br />All othcra $10.00 -- <br /> <br />OTHER (ss requirod by OSPSC <br /> and Buila~t~g <br /> <br />DWELLINO PBRMIT LABEL # of Labels N/C <br /> <br />5. FEnS <br /> Al. Emer total of fees from Sec. <br /> A2. Add 5% a~h~ (.05 x Al) <br /> ~bto~l <br /> <br /> B. ~ter 2~ of I~o A 1 for Pl~ <br /> <br /> D. Re,pectin Fee ($25.~) <br /> <br /> <br />