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F~R CITY VALIDATIONI <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br />COMMUNITY DEVELOPMENT CENTER <br />285 Church St NE · Room 132 <br /> Salem, OR 97301 <br /> <br /> 24 hr. Inspection Line 373-4427 <br />Office: Phone $88-5147 8:00am - 4:30pm <br />FAX: 588-7948 <br /> <br />PLUMBING PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />l. LOCATION OF INSTALLATION <br /> <br />Pro.ny owner <br /> <br />Cross Street/Directions: <br /> <br />.lob Description: <br /> <br /> PER,firs ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT <br /> STARTED WITHIN 150 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />Mailing Address <br /> <br />Plumbing Board: <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br />~er'a Si~at~: <br /> <br />Agent's Si~mm: <br /> <br />PERMIT NO: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />4. FBB SCHBDUL~ (Complete and enter Iotal in Al below) <br /> <br /> RESIDENTIAL ~ COMlVIISRCIAL [] <br /> USE OF STRUCTURB: <br /> NEW m ALTERATION o ADDITION o RELOCATION <br /> <br /> No. X F~ = Sum <br />BASE FEE $2O. OO <br /> <br />RESIDENTIAL (~¢h frxmre) <br /> Au~ra Dwelling Plumbing Fee __.sq. fcx $.070 = <br /> <br />Single Family or multi-family <br />dwelling unit <br />New construction $10,00 <br />Alterations $10,00 -- <br /> Reconnect $ 5.00 <br /> Relo~nted Structure $ 5.00 <br /> Modular Structure $ 5,00 -- <br /> <br />Water Lines <br />First 1O0 ft. or fraction thereof $20.00 -- <br />For ea. nddnl' 100 ft. (up to <br />maximum of 5O0 ft.) $15.00 -- <br /> <br />Sanitary & Storm Lines <br />First 100 ft. or fraction thereof $30,00 -- <br />For nddal' I00 ~ (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 /> Reconn~t $10.00 <br /> <br />Water Lines <br />Fwst 100 ft. or fraction thereof $25.00 <br />For ea. nddnl' 100 ft. <br /> <br />Sanitary & Storm Lines <br /> First 100 ft. or fraction thereof <br /> For addnl' 1~0 ft. <br /> <br />$15.00 <br /> <br />$30.00 <br /> <br />$15.00 <br /> <br />PROTECTIVE BACKFLOW DEVICE <br />Lawn vacuum breaker (sprinkler system) $ 4.50 -- <br />All others $10.00 <br /> <br />OTHER (as required by OSPSC <br /> and Building Ol~ciM) <br /> <br />DWELLING PERMIT LABEL # of Labels NIC <br /> <br />3. PLANRBVH~g SBCTION <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. FBBS <br />Al. Entar totaloffees from Sec. ~4 $ <br />A2. Add 5% surcharge (.05 x Al) <br />Subtotal <br /> <br /> B. Enter 25% of line A1 for Plan Review <br /> (Al + .25), if required $__ <br /> C. Investigation Fee (if ~quimd) $__ <br /> D. Reinspeetion Fee ($25.00) $__ <br /> <br /> TOTAL AMOUNT DUB <br /> Receipt No. <br /> <br /> <br />