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FOR CITY VALIDATION <br />Received By: <br /> <br />Date: <br /> <br /> MARION COUNTY <br />BUILDING INSPECTION DIVISION <br />3150 Lancaster Dr. NE - Suite C <br /> Salem, Oregon 97305-1398 <br /> <br /> 24 HR InsI~ction Line 373-4427 <br />Office: phone 588-5147 8:00am - 4:30pm <br />FAX $88-794~ <br /> <br /> PLUMBING PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br />T^XACCO TNO' I I0 IS IL I--I OI° Io <br />iOH~r)RESS q'~5 Ol~ ~ <br />CITY ~ ~S~' Ik <br /> <br />PROPERTY OWNER 5 ~-~- ~'~ ~,1e I~ <br /> 1 l°131-t' l¥1' l-I, I lol,, <br />CROSSSTREET/DIRECTIONS OItn~t~ ~ 1~ <br />PRO~CTDESmPnON 0~1C.~ ~.~A~ <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT <br />STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK 1S SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />Plumbing <br /> <br />~iling <br /> <br />CONT~ORS BO~ <br />~GIST~TION <br /> <br />2B. FOR OVCNER INSTALLATIONS <br /> <br /> Prope~ Owner (please print) <br /> <br /> Mailing Address <br /> <br /> City, Stale, Zip <br /> <br /> Owner's Signature <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 />MC 15-45 7/97 <br /> <br />.9_._-- 2_- qoc'' <br /> <br />Issued by: <br /> <br />4. FEE SCHEDULE (Complete and enter total in 5-Al ~low) <br />RESIDENTIAL [~ COMMERCIAL }~ USE: <br /> NEW [~ ALTERATION ~ ADDITION {~ KELOCA~I~2 <br />BASE FEE Assessed on all applications ($20.00 <br /> (Exception: Watex/Sewer Line Applications w/no <br /> <br />~ OTY OTY <br />AREA DRAIN INTERCEPTOR <br />BACKFLOW 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 HEATER <br />OTHER WET BAR ~ <br /> Total#Fixtures ~ x$10.O0 =$ . <br /> [ x $4.50 = $ <br /> <br />q <br /> <br />Lawn vacuum breaker / sprinkler system <br /> <br />WATER LINES <br /> Residential: First 100 ff., Or fraction thereof x $20.0~ <br /> For ca addn1100 ft Up to 500 feet x $15.00 = <br /> Commemial: First 100 fl. Or fraction thereof <br /> For ea addnl 100 feet x $15.00 = $ <br /> <br /> Residential: First 100ft. Or fraetion thereof x$30.00 =$ <br /> For ea addnl 100 fi, Up to 500 feet x $15.00 = $ <br /> Commercial: First 100fi. Or fmctionthereof ~- x$30.00 =$~ <br /> For ea addnl 100 feet x $15.00 = $ <br /> <br />STORM nRAINS <br /> Residential: First 100fi. Or fmetionthereof x$30.00 =$ <br /> For ea addal 100 fi. Up to 500 feet -- x $15.00 <br /> Commercial: For 100 fi. Or fraction thereof <br /> For ea addn1100 feet x $15.00 = $ <br /> <br />MINOR INSTALLATION LABELS x $50.00 = $ <br />(Pack of 10 labels ~ $5.00 each, sold only to Plumbing contractors) <br /> <br />~ # of Labels N/C <br />(For New Single Family Dwellings Only) <br /> <br />FEES <br /> <br />B. Enter 25% of line Al for Plan Review <br /> (Al + .25), if requi~d <br />C. Investigation Fee (if required) <br />D. Reinspection Fee ($25.00) <br /> <br />Receipt No, <br /> <br />Sublotal <br /> <br />TOTAL AMOUNT DUE <br /> <br /> <br />