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FOR CITY VALIDATION <br /> Received By: <br /> <br />[~ate: <br /> <br />I PLUMBING PERM_IT.APPL!CATION <br />~ Pl~lete all Sections, 1 through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br /> MARION COUNTY <br />BUILDING INSPECTION DIVISION <br />3150 l~nca.~er Dr, NE - Suite C <br /> Salem, Oregon 97305-1398 <br /> <br /> 24 HR iaspeetion Line 373-4427 <br />Office: phone ~88-S147 8:00am - 4:30pm <br />FAX 588-7948 <br /> ] <br /> <br />PERMITS ARE NON-TRANSFERABLE AND E.N~IRE IF WORK IS NOT <br />STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br /> PlumbingCont~aetor Judson'$, Thc. <br /> <br />Mailing <br />Ad.ss P.O. Box 12669 City Salem <br /> <br />FAX 5 0 3 -- ~ <br /> <br /> property Owa~ (p/ease print) <br /> Mailing Address <br /> <br /> Cit~, StYe, Zip <br /> <br /> Owner's Signatur~ <br /> <br /> Agent's Signature <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 />PERMIT NO: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />4. FEE SCHEDULE (Complete and enter total in 5-Al below) <br /> <br />RESIDENTIAL c~ COMMERCIAL [~ USE: <br /> NEW [~ ALTERATION ~ ADDITION ~] RELOCATION <br />BASE FEE Assessed on all applications $20.00 <br /> (Exception: Wnter/Scwer Line Applications w/no fixtures) <br /> <br />~/XTURES OTY OTY <br />ARE~ DRAIN INTERCEPTOR <br />BACIG~LOW PREV DEVICE LAUNDRY TUB <br />BATHTUB RECEPTOR <br />BIDET SHOWER ~ <br />CATCH BASIN SINK <br />CLOTHES WASHER TROUGH DRAIN <br />DENTAL UNIT TUB/SHOWER <br />CUSPIDOR URINAL <br />DRINKING FOUNTAIN WATER CLOSET <br />FLOOR DRAIN WATER I~ATER <br />OTHER WET BAR <br /> <br /> Total # Fixnt~s ~ x $10.00 <br /> <br />Lawn vacuum breaker / sprinkler system -- x $4.50 <br /> <br /> Residential: Fiml00fi-,Orfractinnthereof -- x$20.00 -$ <br /> Foreaaddnl 100 fl Up to 500 fent -- x$15.00 --$ <br /> Commercial: First 100 fi- Or fraction thereof x $25.00 = $ <br /> For ea addnl 100 feet x $15.00 = $ <br /> <br /> Residential: First 100 fl. Or fraction thereof x $30.00 = $ <br /> Foreaaddnl lO0fi-Upte50Of~et __ x$15.00 =$ <br /> Commercial: First 100 fl. Or fraction thereof x $30.00 = $ <br /> For ea addnl I00 feet x $15.00 = $ <br /> <br /> Residential: First 100 ff. Or fracilon thereof x $30.00 = $ <br /> ForeaaddnllO0fi-Upto500 feet __ x$15.00 --$ <br /> Commercial: For 100 fi- Dr fraction thereof x $30.00 -- $ <br /> For eaaddnl 100 feet x$15.00 =$ <br /> <br /> --$ <br /> <br />MINOR INSTALLATION LABELS x $50.00 <br />(Pack of 10 labels ~ $5.00 each, sold only to Plumbing contractom) <br /> <br />~ # of Labels -- <br />flor New Single Family Dwellings Only) <br /> <br />= $ ,/~,0( <br />=$ <br /> <br />N/C <br /> <br />FEES <br /> <br />Subtotal <br /> <br />B. Enl~r 25% of line Al for Plan Review <br /> (Al + .25), if required <br />C. Investigation Fee (if mquired) <br />D. Rei~pection Fe~ ($25.00) <br /> TOTAL AMOUNT DUE <br />Receipt No,__ <br /> <br />MC 15-45 7/97 <br /> <br /> <br />