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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 Inspection Line 373-4427 <br />Office: phone 588-5147 8:~0am - 4:30pm <br />FAX 588-7948 <br /> <br />Issued by: <br /> <br /> PLUMBING PERMIT APPLICATION <br />Please complete all Sections, 1 through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br /> TAX ACCOUNT NO. <br /> <br />OWNER'S <br />PHONE # <br /> <br /> CROSS STREET/DIRECTIONS <br /> <br /> PROJECT DESCRIPTION <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 /> <br />PlumbingCont~actor )e~ 113-- Vj~)l ~ PL~m~)~O'I <br /> <br /> Mailing <br /> <br />PHO> O 3 -7 q 2_ <br />PAX 16-1o1 1-171, Izl <br /> <br /> CONT~CTO~ BOA~ I ~ ] / I <br /> I I t I <br /> <br /> t <br /> <br />2B. FOR OW~R INSTALLA~ONS <br /> <br />-3qo/ <br />-1 1'7 o / <br />-2 ZO PB <br /> <br /> Proper~ Owner (please print) <br /> <br /> Mailing Address <br /> <br /> Cit~, State, 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 />4. FEE SCHEDU7 (Complete and enter total in 5-A! b~low) <br />RESIDENTIAL ~ COMMERCIAL ~ USE: <br /> NEW ~ ALTERATION ~ ADDITION ]~RELOCATION {~ <br />BASE FEE Assessed on all applications $20.00 <br /> (Exception: Water/Sewer Line Applications w/no Bxtures) <br /> <br />FIXTURES OTY OTY <br />AKEA DRAIN rNTERCEPTOR <br />BACKFLOW PR~V 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 ti Fixtures x $10.00 = $ <br />Lawn vacuum breaker / sprinkler system -- x $4.50 = $ <br /> <br /> Residential: First l00 ft., Or fracfion thereof -- x$20.00 =$ <br /> For ea addnl l00 ~ Up to 500 feet __ x$15.00 =$ <br /> Commercial: First 100 ft. Or fraction thereof x $25.00 = $ <br /> For ea addn1100 feet x $15.00 = $ <br /> <br /> Residential: First 100ft. Or fra¢tion thereof x$30.00 =$ <br /> For ea addnl l00 fL Up to S00 feet __ x$15.00 =$ <br /> Commercial: First 100 ft, Or fraction the~of x $30.00 = $ <br /> For ea ad~nl I00 feet x $15.00 = $ <br /> <br />STORM DRAINS <br /> Residential: First 100 tL Or fraetinn thereof x$30.00 =$ <br /> Foreaaddnll00~.UptoS00feet __ x$15.00 =$ <br /> Conunercial: For 100 fL Or fraction thereof x $30.00 = $ <br /> For ea addn1100 fe~t 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 />DWELLING PERMIT LABELg ti of Labals N/C <br />(For New Single Family Dwellings Only) <br /> <br />5. FEES <br /> Al. Enter total of fees from Sec, #4 <br /> A2. Add 5% surcharge (.05 x Al) <br /> <br />B. Emer 25% of line A 1 for Plan Review <br /> (Al + .25), if required <br />C. Investigation Fee (if required) <br />D. Reinspection Fee ($25.00) <br /> <br />Receipt No. <br /> <br />Subtotal <br /> <br />TOTAL AMOUNT DUB <br /> <br />MC 15-45 7/97 <br /> <br /> <br />