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MARION COUNTY BUILDING INSPECTION <br /> <br />IFOR CITY VALIDA ,T~,ON{ <br /> R~ceived by:~ <br /> Date: ~'- 2~ ~2' <br /> <br /> PLUMBING PERMIT APPLICATION <br /> Please complete all 8octions, I through <br /> <br /> 1. LOCATION OF INSTALLATION <br /> <br />lobAdd~ 945 01ney <br /> <br />COMMUNITY DEVELOPMENT CENTER <br />285 church St NE · Room 132 <br /> Salem, OR 97301 <br /> <br /> 24 hr. Inspection Line 3734427 <br />Office: Phone 588-5147 8:00am - 4:30pm <br />FAX: 588-7948 <br /> <br />a~ Aumsville Cmsa~ 9th <br /> <br />~p~yown~ Shetler & Shetler p~me 749-1900 <br /> <br />Pesc~pfi~n/D~cgo~: East on 01ney off of Aumsville <br /> Hwy. to Blazer <br /> <br />PI~MITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK 15 NOT <br />STARTI~ WITHIN 180 DAYS OF ISSUAN CE OR IF <br /> WORK l~ SUSPENDED FOR 180 DAYS, <br /> <br />%at. CONTRACTOR INSTALLATION ONLY <br />Cont~or Blazer Industries, IncI Phone 749-1900 <br /> <br />.I ob No. <br /> <br />MailingAddgas PO BOX 489 <br /> <br />~umbi~Board: 24-358PB <br /> <br />Con~¢~r'sBoardP-zg. No. 50106 <br /> <br />Journeyman's Plumbe~ No. 4644JP <br />Ce~tractor'. Sisnnture: <br /> <br />liB. FOR OWNBR INSTALLATIONS <br />Property Owner ~t~o pri~) <br /> <br />Maitin~ Address [ Phone <br />City/S ~a~./Zip <br />Owner's Signatum: <br />Agent's Signature: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />4. ~ $CHBDUL~ (Complc~ nnd ent/x tolal in Al below) <br /> <br /> RIL~iDBIqTIAL [] COMMBRCIAL ~ <br /> USE OF STRUCTURe: <br /> NEW [2 ALTI~KATION~ ADDITION [2 RELOCATION <br /> <br />BASE FEE I20.00 <br /> <br /> maximum of 500 fl.) <br /> <br /> For addnl' 100 fi. (up to <br /> maximum of 500 fl,) <br /> <br />COMMERCIAL (each ftxture) <br /> <br />$15.00 <br /> <br />$30.00 <br /> <br />$15.00 -- <br /> <br />~.~ x $10.00 <br /> $10.00 -- <br /> $10.00 __ <br /> <br />Water Lines <br />First 100 fl. or fraction Ihemof $25,00 <br />For ea. nddnl' 100 ft. <br /> $15.00 -- <br /> <br />Sanitary & SIorm Lin~ <br /> Fimt 100 fl. or fraction glcreof <br /> For addnl' 100 fl, <br /> <br />$30.00 -- <br />$15.00 -- <br /> <br />Lawn vacumn breaker (sprinkler system) $ 4.50 -- <br />All o[hers $10.00 <br /> <br />OTHBR (as tequit~dbyOSPSC <br /> end Building Ol~clal) <br /> <br />DWELLING PBRM IT LABEL # of Labels NIC <br /> <br />3. PLANR~¥1BW 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. F]H~S <br /> Al. Enter total of fe~ from See.//4 $ <br /> <br /> B. ~mr 25% of l~e A 1 for PI~ Renew <br /> <br /> C. Investigation ~ (if ~u~) $ <br /> D. Re~afion F~ (~5.~) $ <br /> <br /> No. <br /> <br /> <br />