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FOR CITY VALIDATIONI <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 />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 <br />FAX: 588-7948 <br /> I <br /> <br /> NON-TRANSFERABLE AND EXPII~E IF WORK IS NOT <br />STAR'[~D WITHIN 1~0 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br /> CONTRACTOR INSTALLATION ONLY <br /> <br />MailingAddmss ~.-Ig~,O ~.~ ~ ~ <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br />Property Owner (plasseptint) <br /> <br />Mailing Address <br /> <br />City/State/Zip <br /> <br />Owner's Signature: <br /> <br />Agent's Signature: <br /> <br />PERMR' NO: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />4. FEE SCHI/DULE (Complete and ente~'-~tal in Al below) <br /> <br /> USE OF STRUCTURE: <br /> NEW ~1 ALTERATION El ADDITION El RELOCATIO'~D <br /> <br /> No. X Fee --$~.'m2~0 <br />BASE FEE <br /> <br />RESIDENTIAL (each fLxture) o <br /> Aurora Dwelling Plumbing Fee sq. ft. x $.070 = <br /> <br /> New construction ~ q $10.00 -- <br /> Alterations _, / $10.00 -- <br /> Reconnect ~ $ 5.00 -- <br /> Relo~atad Structure ~\~'~ $ 5.00 <br /> ModularStructure(~"'~ $ 5.00 -- <br /> <br />Water Lines <br />F~rat 100 ft. or fraction thereof $20.00 -- <br />Fore& addnl' 100 ft. (up to <br />maximum of 500 fl.) $15.00 -- <br /> <br />Sanitary & Storm Lines <br />First 100 ft. or fraction thereof $30.00 -- <br />For addnl' 100 ft. (up to <br />maximum of 500 fl.) $15.00 __ <br /> <br />COMMERCIAL (each fixture) <br /> <br /> New construction $ I0.00 -- <br /> Alterations $ <br /> Reconnect $10.00 <br /> <br />Water Lines <br /> First 100 fl. or fraction thereof <br /> For ea. addnl' lO0 ft. <br /> <br />Sanitary & Storm Lines <br /> First 100 fl. or fraction thereof <br /> For addnl' 100 ft. <br /> <br />$25.00 <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 $10.00 -- <br /> <br />OTHER (as tvquiredbyOSPSC <br /> and BuilcEag O[~ciaD <br /> <br />DWELLING PERMIT LABEL ff of Labela N/C <br /> <br />3. PLAN REVIEW SECTION <br /> <br />Marion County does not require a plan review. <br />We will provide plan review service if you complete <br />Section 5B and submit two (2) sets of plans and <br />specifications with this application. <br /> <br />MC 15-45 <br />Rev. 1/96 <br /> <br />5. FEES <br /> (A 1. Entar total of fees from S~c.//4 <br /> ~!A2. Add 5% surchargn (.05 x Al) <br /> <br />Subtotal <br /> <br />$ <br />$ <br />$ <br /> <br />B. Enter25% of lineAl forPlan Review <br /> (Al + .25), if required $ __ <br />C. Investigation Fee (if required) $__ <br />D. Reimpection Fee ($25.00)TOTAL AMOUNT DUE ~_~* <br />Receipt No. <br /> <br /> <br />