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FOR CITY VALIDATION[ <br />Received by: <br />])ate: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> 285 Church St NE · Room 132 <br /> Salem, OR 97301 <br /> <br />24 Hr Inapection Line: 588-7904 <br />Office: 588-5147 8:00 a.m. - 4:30 p.m. <br />FAX: 588-7948 <br /> <br />PLUMBING PERMIT APPLICATION <br />Please complete all Sections, I through <br /> <br />1. LOCATION OF IN~rALLATION <br /> <br />PERMITS ARE NON-TRANSFERABLE AND ILX. PIRE IF WORK IS NOT <br />STARTED WlTHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br /> I <br /> <br />~. FOR O~R ~T~LATIONS <br /> <br />Property O~er (ple~~ prird) <br /> <br />Mailinff Addr~s I Phone <br /> <br />City/State/Zip <br /> <br />Owner's Signature: <br /> <br />Agent's Signatttr~: <br /> <br />3. PLAN P..EVIEW SECTION <br /> <br /> PERMIT NO: ~ <br /> <br /> Date: <br /> Issued by: ~11~}! ~ '~ '' <br /> <br /> INSPECTION <br />4, FEE $CHNDULE ~ p rm Al be~w) <br /> ~~ ~ CO~C~ ~ <br /> USE OF ~UC~E: <br /> N~ ~ ~ON ~ ~DfflON ~ ~OCATION ~ <br /> <br /> No. X Pe~ = 8urn <br /> BASE FEE $20.00 <br /> <br />RESIDENTIAL (each fixmxe) <br /> Atmara l)welL/ng Plumbing Fee -- sq. fl, x $.065 = -- <br /> <br />dwelling unit <br />New construction $10.00 <br />Alterations $10.00 <br />Reconnect $ 5.00 <br />Relocated Slructore $ 5.00 <br />Modular Sa'ueture $ 5.00 <br /> <br />Wator Lines <br />First 100 fi. or fraction thereof $20.00 -- <br />For ea~ addnl' 100 ft. (up to <br />maximum of 500 ft.) $15.00 <br /> <br />Saaitety & Storm Lines <br />First 100 ft. or fraction ~ea~of $30.00 -- <br />For addnl' 100 tL (up to <br />maximum of 500 ft.) $15.00 -- <br /> <br />COMMERCIAL (each fixture) <br />New construction //~ $10.00 ~/t/O*~''' <br />Alterations $ ILL00 -- <br />Reconnect $10.00 <br /> <br />Water L/n~a <br />First 100 fl. or fraction ~hereof $25.00 <br />For ea. add/Il' 100 iL <br /> <br />Sanitary & SUmu IAnos <br /> First 100 iL or fraction thereof <br /> For addnl' 100 fl. <br /> <br />$15.00 <br /> <br />$30.00 <br /> <br />$15.00 <br /> <br />PROTECTIVE BACKFLOW DEVICE <br />Lawn vacuum breaker (spunkier system) $ 4.~ ~ <br />All o~em $10~ <br /> <br />OTHER (asr~quit~dbyOSPSC <br /> and Buil&'ng O~ciM) <br /> <br />DWELLING PERMIT LABEL # of Labels N/C <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.g/WS <br /> <br />5. FEES <br />Al, Enter total of fees from Sec, #4 <br />A2, Add 5% surcharge (.05 x Al) $. <br /> Subtotal $ <br /> <br /> B. ~r25% ofl~eAl for Pl~ew <br /> (Al + ,25), if m~imd $.~ <br /> C. lmestigafion ~ (if~q~d) $.~ <br /> D. Re~pection Fee ($25.~) $.~ <br /> <br /> ~T~ ~O~ D~ $.~ <br /> Receipt No. <br /> <br /> <br />