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FOR CITY VALIDATION[ <br />Received by: <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 />2..4 Hr InZpeotinn Linc: 588-7904 <br />Oflloe~ 588-5147 8:00a.m.-4:~Op.m. <br />FAX: 588-7948 <br /> <br />PLUMBING PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />D~wdption/Dim~ticm: <br /> <br />PERM2~ ARE NON-TRANSFERABLE AND EXPIRE IF WORK 1S NOT I <br /> STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDI~) FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />Co..a~ Jnd~-on' s~ Inc. [ l~o~e 363-4~ 41 <br />~iling^a~r~ P.O. BOx ~2669 Salem, OR 97309 <br /> <br />Plumbing Board: 24-22PB <br /> <br />211, FOR OWNER INSTALLATIONS <br /> <br />Pmp~ny Owner (p!e~ se print) <br /> <br />M~iling Addr~z Phone <br /> <br />3. PLAN REVIEW SECTION <br /> <br />PERMIT NO: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />4. FIlE SCHEDULE (Comploto and ~otalin A1 b~low) <br /> <br /> ~~ ~ CO~C~ ~ <br /> US~ OF ~UC~: <br /> NEW U AL~TION~D~ION U ~OCATION U <br /> <br /> No, X F~ = ~m <br /> <br /> A~ ~e~ Pl~b~ F~ ~ sq. f~ x $.~ = <br /> <br />S~g[~ P~fly or muld-f~ily per <br />dwcHiog ~ft <br /> <br /> Aft~o~ / Sl0.~ ,/~ <br /> Re~ect $ 5.~ <br /> Re~n~ Stmct~ $ 5.~ <br /> Mo~lnr S~ct~ $ 5.~ <br /> <br />First 1130 fi. or fraction thereof $20.00 <br />For ea. addfll' 100 ft. (up to <br />maximum of SO0 ft.) $15.00 <br /> <br />maximum o f 500 ft.) $15.00 -- <br /> <br />Water Line~ <br />Ftrst 100 ft. or fraction Ihcmof $25.00 <br />For ca. addfll' 100 fl. (up m <br />n~ximum of 500 fL) $15,00 -- <br /> <br />Snni~ary &Smvm Linez <br />Firm 10() ft. or fraction Ihcreof $30.00 <br />For addnl' 100 ft. (up m <br />maximum of 500 ft.) S 15.00 <br /> <br />PROTECTIVE BACKFLOW DEVICE <br /> Lawn vacuum breaker (sprinkler systmn) <br /> All o~h~rs <br /> <br />$ 4,50 <br />$lO.00 <br /> <br />N/C <br /> <br />Marion County does not require a plan review. <br />We will provide plan review service if you complete <br />Section 53 and submit two (2) sets of plans and <br />specifications with this application. <br /> <br />~ 15-45 <br />Rev. 12/9,1 <br /> <br />5. FEES <br /> Al. Enter total of fees from S~. ~4 <br /> A2. Add 5% surcharge (.05 x Al) <br /> <br /> B. Enter 25% of line A 1 for Plan Review <br /> (A 1 + .25), if required <br /> C. Investigation Fee (if r~quir~l) <br /> D. R/zinspection Fee ($25.00) <br /> <br /> TOTAL AMOIJNT DUE <br /> Receipt No. <br /> <br /> <br />