Laserfiche WebLink
FOR CITY VALIDATIONI <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 Inspection Line 373-4427 <br />Office: phone 58~5147 8:00am - 4:30pm <br />FAX $88-7948 <br /> <br /> PLUMBING PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br /> JO. ADDRESS Ilqgit Oo.v <br /> <br /> CITY ~ ~t[I ~ <br /> PROPERTY O~ER tOq/, ~ [,_~ <br /> <br /> cgoss ST~Tml~CnONS G~ ~ <br /> <br /> PRO,CT DESC~ION <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXPIRE 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 />Plumbing Contractor <br /> <br />Mailing <br />Address <br /> <br />PLUMBING BOARD NO. <br /> <br />CONTRACTORS BOARD <br />REGISTRATION NO. <br />JOURNEYIvlANS <br />PLUIviBERS NO. <br /> <br />CONTRACTOR'S SICJNATURE <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> PropertyOwncr(pleo.*eprint) {~ :l [~r.l~,x. ~'~ ~ <br /> MailingAa~ess //q~3 ~ ~ <br /> Ci*,S~e, Zip :lie,O <br /> <br />Phone, Istol _ I-I qlsl /I/Iv.l.7 <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 &plans and <br /> specifications with this application. <br /> <br />MC 15-45 7/97 <br /> <br />PERMIT NO: <br /> <br />Date: <br /> <br />Issuedby: <br /> <br />4. FEE SCHEDULE (Complete and en~r total in 5-Al below) <br /> <br />RESIDENTIAL O COMMERCIAL [~ USE: <br /> <br />BASE FEE Assessed on all applications $20.00 <br /> (Exception: Water/Sewer Linc Applications w/no fixtures) <br /> <br />AREA DRAIN <br />BACKFLOW PREV DEVICE <br />BATHTUB <br />BIDET <br />CATCH BASIN <br />CLOTHES WASHER <br />DENTAL UNIT <br />CUSPIDOR <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />OTHER <br /> <br />OTY OTY <br />INTERCEPTOR <br />LAUNDRY TUB <br />RECEPTOR <br />SHOWER <br /> SINK <br /> TROUGH DRAIN <br /> TUB/SHOWER <br /> URINAL. <br /> WATER CLOSET <br /> WATER HEATER <br /> WET BAR <br /> <br />Total # Fixtures x $10.00 = $ <br /> <br />Lawn vacuum breaker/sprinkler system __ x $450 = <br /> <br />WATER LINES <br /> Residential: First 100 it., Or fraction thereof ] x $20,00 = <br /> Foreaaddnll00t~UptoS00feet __ x$15,00 =$__ <br /> Commercial: First 100 it. Or fraction thereof x $25.00 = $ <br /> For ea addn1100 feet x $15,00 = $ <br /> <br /> Residential: First 100 it. Or fraction thereof x $30.00 = $ <br /> For ea addnl 100 ft. Up to 500 feet -- x $15.00 <br /> Commercial: First 100 it. Or fraction thee, of x $30,00 = $ <br /> For ea addnl 100 feet x $15,00 = $ <br /> <br />STORM DRAINS <br /> Residential: First 100 it. Or fraction thereof x $30.00 = $ <br /> For eaaddnl 100 ~.Upto 500 feet x$15.00 =$__ <br /> Commercial: For 100 it. Or fraction the~-of x $30.0~ = $ <br /> For eaaddnl 10~ feet x$15.00 =$ <br /> <br />MINOR INSTALLATION LABELS x $50,00 = $ <br />(Pack of 10 labels ~ $5.00 each, sold only to Plumbing contractors) <br /> <br />~ # of Labels N/C <br /> <br />(For New Single Family Dwellings Only) <br /> <br />$. FEES <br /> <br />B. Enter 25% of line Al for Plan Review <br /> (Al + .25), if required <br />C. Investigation Fee (if requlred) <br />D, Reinspection Fee ($25.00) <br /> <br />Receipt No. <br /> <br />Subtotal <br /> <br />TOTAL AMOUNT DUE <br /> <br /> <br />