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[FOR CITY VALIDATION <br /> Received by: <br /> Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNrrY DEVELOPMENT CENTER <br /> 285 Church St NE · Room 132 PERMIT NO: <br /> Salem, OR 97301 <br /> <br /> 24 hr. Inspection Line 373-4427 <br />Office: Phone 58~-$147 S:00am - 4:30pm <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 />ST~ ~ 1~ DAYS OF ~SUAN~ OR IF <br /> <br />2A. CONTRACTOR INfiTALLATION ONLY <br /> <br />Mailing Address <br />Pl0mbing Board: <br /> <br />Job No. <br /> <br />Contractor's Board Reg. No. <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br />Mailing 7 /'zS s7 <br /> <br />_Owner's Signat~ ,-~ <br />Agent,s S ~gnL'"gn~tatur~: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />4. FE]~ SCHBDUL~ (Complete and enter lotalinAl below) <br /> RtiSIDBNTIAL J~ CO~CI~ <br /> US~ OF S~UC~: <br /> NEW ~ AL~ON ~ ADDfflON ~ R~OCA~ON <br /> <br /> No. X Fee = Sum <br />BASE FEE $20.00 <br /> <br />RESIDENTIAL (each fcxture) <br /> Aurora Dwelting Plumbing Fee __.sq. fl. x $.070 = <br /> <br />Single Family or multi-family per <br /> <br /> Alterations ~ $10.00 7-~ <br /> <br />Water Lines <br />F~mt leo fl. or fraction thereof $20.00 -- <br />For ea. addnl' 100 fl. (up 1o <br />maximum of 5oo ft.) $15.00 -- <br /> <br />Sanitary & Storm Lines <br />F/mt 100 fl. or fraet/on thereof $30.00 -- <br />For adflnl' 100 fl./,up to <br />maximum of 500 ti.) $15,00 -- <br /> <br />COMMBRCIAL (each fixture) <br /> <br /> New consh~uction $ I0.00 -- <br /> Alteratio~ $10.00 <br /> Reconnect $10.00 -- <br /> <br />Water Lines <br /> First 100 fl. or fraction thereof <br /> For ea. addal' 100 fl. <br /> <br />$25,00 -- <br />$15.00 -- <br /> <br />$30.00 -- <br />$15.00 __ <br /> <br />PROTECTIVE BACKFLOW DEVICE <br />Lawn vacuum breaker (sprinkler sysl~m) $ 4.50 -- <br />~ All othem $10.00 <br /> <br />OTHER ~asrequiredbyOSPEC <br /> and Bmldif~g Ot~¢iaD <br /> <br />DWELLING PERMIT LABEL #of Labeh ~/C <br /> <br />3. PLAN RBVIBW 5BCTION <br /> <br />Marion County does not require a plan review. <br />We will pwvide 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. F~IIS <br />Al, Enter total of fees from S~c. #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 required) <br /> D. Rein~pectinn Fee ($25.~0) $ <br /> <br /> TOTAL AMOUNT DUE $ <br /> Receipt No. <br /> <br /> <br />