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FOR CITY VALIDATION[ <br />R~e~ived by: I <br />Date: [ <br /> <br />PLUMBING PERMIT APPLICATION <br />Please complete all ~ections, I through <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />Vt' MARION COUNTY <br /> ~ BUILDING INSPECTION DIVISION <br /> 3150 LANCASTER DR NE -SUITE C <br /> SALEM OR 97305-1398 <br /> <br /> 24 hr. Inspection Line 373-4427 <br />Office: Phone 588-5147 $:00am - 4:30pm <br />FAX: 588-7948 <br /> I <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT I <br /> I <br /> STARTED WITHEq 180 DAYS OF ISSUANCE OR IF <br /> <br />liB. FOR OWNBR INSTALLATIONS <br /> <br />Property Owner (plo~so print) <br /> <br />Mailing Addreas I Phone <br /> <br />[CTION <br />~R <br /> PERMIT NO: <br /> <br /> Date: <br /> <br /> Issued by: <br /> <br />Agent's Sig~auce: <br /> <br />4. FEE SCHEDULE (Complete and ente~ Iota] in Al below) <br /> <br /> RESIDENTIAL ~n COMMERCIAL ~ <br /> USE OF STRUCTURE: <br /> NEW C] ALTERATION ~l ADDrrlON.~ RELOCATION <br /> <br /> No, X Fe~ = Sum <br />BASE FEE $20.00 <br /> <br />RESIDENTIAL (each fixture) <br /> Aurora Dwelling Plumbing Fee ___sq, fl. × $,070 = <br /> <br />Single Family or multi-family per <br />dwelling unit <br />New conslruchon $10.00 <br />Alterations ~ $10.00 _7~ <br /> Reconnect $ 5.00 -- <br /> Relocated Structure $ 5.00 -- <br /> Modular Structure $ 5.00 -- <br /> <br />Waler Lines <br />First 100 fl. or fraetinn thereof $20.00 -- <br />For ea. addal' 100 ft. (up to <br />maximumofS00 ft.) $15.00 -- <br /> <br />Water Lines <br /> First 100 fl. or fraction thereof <br /> For ea. addnl' 100 fl, <br /> <br />$25.00 -- <br />$ i5.00 -- <br /> <br />Sanitary & Storm Lines <br /> First 100 fl. or fraclion thereof <br /> For addni' 100 ft. <br /> <br />$30.00 -- <br />$15.00 -- <br /> <br />PROTECTIVE BACKFLOWDEVICE <br />Lawnvacumnbg~(spr~ldersys~m) $4.50 -- <br />Allothe~ $10.00 -- <br /> <br />OTHBR (as required by OSP$C <br /> and Butl~ng O[~cial) <br /> <br />DWELLING PERMIT LABEL # of Labels <br /> <br />NIC <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. Fr~S <br /> Al. Enter total of fees from Sec. #4 <br /> A2. Add 5% surcharge (.05 x Al) <br /> Subtotal <br /> <br /> B. Prater 25% of line A1 for Plan Review <br /> (Al + .25), if required <br /> C. Investigation Fee 0f required) <br /> D. Reinspectinn Fee ($25.00) <br /> <br /> TOTAL AIvlOUNT DWE <br /> Receipt No. <br /> <br /> <br />