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MARION CO IN ECTION <br /> COMMUNITY t;~i~0'E'L~Itt, I~.,NT CENTER. <br /> 2S~ ~i~'I~"~i~n[ t32 PI::RMIT NO: <br /> Salem, OP, '!77301 . <br /> ~ARION COUNTY Date: <br /> <br /> Office: Phone~SK-~T47--ff':Offl'M'- 4:30pm 15suod by: <br /> FAX: 588-?948 <br /> <br />PLUMBING PERMIT APPLICATiON ] <br />P/ease complete afl Sections, I through 5 <br /> I <br /> <br />1. LOCATION 0t~. nfl'STALLATION <br /> <br />CONTRACTOR I~STALLATION ONLY <br /> <br />Mail'ms Address <br /> <br />Plumbing Board: <br />Contractor's Board Reg. No. ] /ob No. <br />Journeyman's Plumbers No. <br /> <br /> FOR OWNItR INSTALLATIONS <br />Pror~rty Owner (plea~ prinO <br /> <br />4. FEB SCHEDUL~ (Complete and enter toufi hi Al below) <br /> <br /> RF~I])ENTIAL 12 COMMI~CIAL <br /> ~E OF ~UC~: <br /> NEW ~ AL~ON ~ ~DfflON ~ ~OCATION <br /> <br /> No. X Fee = SUm <br />BASE FEE $20.00 <br /> <br />RESIDENTIAL (each fLxmre) <br /> Aurora Dwelling Plumbing Fee __sq. fl. x S.070 <br /> <br />Single Family or multi-family per <br />dwelling unit <br />New construction $10.00 <br />Alterations $10.OO <br />Recoamct $ 5.00 <br />Relocated Stmctu~ $ 5,00 <br />Modulnr Structure $ 5.00 <br /> <br />maximum of 500 fl.) $15.OO <br />maximt~n of Soo fi.) $15.00 <br /> <br />$15.00 <br /> <br />PROTECTIVE EACKFLOW DEVICE <br /> Lawn vacuum breaker (sprinkler system) <br /> All others ] <br /> <br />OTHER (as cequired byOSPSC <br />~nd fu~Iddng Ol~ciM) <br />DWELLING PEEMIT LABEL # of Labels <br /> <br />$4.50 <br />$1O.OO <br /> <br />N/C <br /> <br />3. PLA~ILEV/BW 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 />R~v. 1/96 <br /> <br />5. FF~E8 <br /> A 1. Enter total of fees from Sec, <br /> A2. Add 5% surcharge (.05 x Al) <br /> <br />Subtotal <br /> <br />B. Enter 2,5% of line A I for Plan Ravicw <br />(Al + .25), if required $.__ <br />C, InvestigatlonFee(ifrequired) , ~ $.__ <br />D. -- . C~ 2F'~.~~ $ <br /> <br /> · ,-,/~ ~,,TOrAL AMOUrZr DU~ <br /> <br /> <br />