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IFOR CITY VALIDATION[ <br /> Reeelved by: <br /> Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br />COMMUNITY DEVELOPMENT CENTER <br />285 Church St NE · Room 132 PERMIT NO: <br />Salem, OR 97301 Date: <br /> <br /> 24 hr. Inspection Line 373-4427 <br />Office: Phone 588-5147 8:00am - 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 />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />Plumbing Board: ,,~ - ~t~) P/~ <br />Co~tractor% Signature: <br /> <br />217. FOR OWNER INSTALLATIONS <br />Ptopert~ Owner (pIeasaprint) <br /> <br />Mailing Address I Phone <br /> <br />City/gtatedZ~p <br /> <br />Owner's Signatuw: <br /> <br />Agent's Signature: <br /> <br />Issued by: <br /> <br />4. FEB $CHBDUI~ (Complete and enter tetal in A1 below) <br /> RI/SIDI/IqTIALX~ COMMERCIAL ~ <br /> USB OF STRUCTURE: <br /> NEW D ALTERATION ~ ADDIT1ON O RELOCATION <br /> <br />BASE FEE <br /> <br />RESIDENTIAL (each fixture) <br /> Aurora Dwelling Plumbing Fee <br /> <br />Single Family or multi4amily per <br />dwelling unit <br /> New construction <br /> Alterations <br /> Reconnect <br /> <br />No, X Fee = ~um <br /> <br />__sq. ~. x $.070 - <br /> <br /> $1o.oo __ <br /> $10.00 <br /> s 5.00 <br /> $ 5.00 <br /> $ 5.00 <br /> <br />Water Lines <br />lrtrst 100 ft. or fraction thereof $20.00 -- <br />FOr ea. addnl' i00 fl. (up to <br />maximum of 500 ft.) $15.00 -- <br /> <br /> For addnr 100 ft. (up to <br /> m~ximum of 500 fl.) $15.00 <br /> <br />COMMERCIAL (each fLxture) <br /> <br /> New cons~¢t~on $ [0,00 <br /> <br />Water Lines <br /> First 100 fl. or fraction thereof <br /> For ea. addnl' 100 ft. <br /> <br />$25.00 <br /> <br />$15.00 -- <br /> <br />Sanita~ & Storm Lines <br /> First 100 fl. or fraction thereof <br /> For addnU 100 ft. <br /> <br />$30.00 <br /> <br />$15.00 <br /> <br />PROTECTIVE BACKFLOW DEVICE <br />Lawn vaeuta~n breaker (sprinkler system) $ 4.50 <br />All others $10.00 -- <br /> <br />OTHER (asrequiredbyOSPSC <br /> and Building Olficial) <br /> <br />DWELLII~3 PERMIT LABEL # of Labels ~ <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. l/96 <br /> <br />5. F~BS <br /> <br /> A2. Add 5% s~harge (.05 x Al) <br /> Subt~al $.__ <br /> <br /> B. Enter25% of lineAl forPinn R~view <br /> (Al + .25), if ~u~d $_~ <br /> C. lnvestiga~on FOe (if~qu~d) $~ <br /> D. Re~peetinn Fee ($25.~) $_~ <br /> <br /> R~eipt <br /> <br /> <br />