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IDFOR CITY VALIDATION <br /> <br /> Received By: <br /> <br /> ate: <br /> <br /> MARION COUNTY <br />BUILDING INSPECTION DIVISION <br />3150 Lam:asker Dr. NE - Suite C <br /> Salem, O~egon 97305-1398 <br /> <br /> 24 HR Insp~fion Line 373-4427 <br />Office: phone 588-5147 8:00am - 4:30pm <br />FAX 588.7948 <br /> <br />PLUMBING PERMIT APPLICATION I <br />Please complete all Sections, 1 through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />PRelECT DESCRiPTION <br /> <br />IpEILMITS ARE NON-TRANSFERABLE AND EXPIRE 1F WORK IS NOT <br /> STARTED WITHIN 150 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR lgO DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />2B. FOR OWNER <br /> <br />PERMIT NO: ~'~'"' ff-~2~ / <br /> <br />Date: <br /> <br />Issued by: <br /> <br />4. ~F~ SCH~]~ULE (Complete itoA ent~ ~ ia 5-Al ~low) <br />~SIDENTIAL ~ COMMERC1A~ ~ USE: <br />~w ~ ~o~ <br />BASE FEE A~es~d on all applications $20.~ <br /> (Exception: Water/S~er L~e Applic~s ~/~o <br /> <br />~ OTY <br />AREA DRAIN INTERCEPTOK <br />BACK[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 HEATER <br />OTHER WET BAR <br /> <br />Total # Fixtures "'~O x $10.00 TM $ __ <br /> x $4.50 = $__ <br /> <br />Lawn vacuum breaker / sprinkler system <br /> <br /> Residential: Firstl001~.,orfractionthareof -- x$20,00 =$ <br /> Foreaaddnll00ffUpto50Ofeet -- x$15,00 =$ <br /> Commetclal:FirstlOOft. or fractlon thereof -- x$25.00 =$ <br /> Foreaaddnl 100feet __ x$15.00 =$ <br /> <br /> Residential: First 100 ~. Or fraction thereof x $30.00 = $__ <br /> x $15.00 =$__ <br /> For ea addn1100 t~. Up to 500 fe~t <br /> x $30.0~ = $__ <br /> Commercial: First 100 R. Or fraction thereof <br /> For ea addnl 100 fe~t x $15.00 = $__ <br /> <br /> ~TORM nRAINS <br /> ResidentiaL: Fimtl00tLOrfractiontbereof x$30.00 =$__ <br /> For eaaddnl 100 ft. Up to 500 feet x$15.00 =$ <br /> Commerciak For 100 ~. Or fraction thereof x $30.00 -- $ <br /> addnl 100 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 /> ~ # of Labels N/C <br /> (F or New Single Family Dwellings Only) <br /> <br />3. PLAN REVIEW SECTION <br /> <br /> Marion CounVy docs 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 />5. FEES <br />Al. Enter total of fees from Sec. #4 $ <br />A2. Add 5% su~harge (.05 x Al) $ <br /> Subtolal $ <br /> <br />B. Enter 250/* of line A ! for Plan Review <br /> (Al + .25), if required <br />C. Investigation Fee (if required) <br />D, Reinspection Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br />Receipt No.__ .- <br /> <br />MC 15-45 7/97 <br /> <br /> <br />