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Received By: 1 <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 8:00am - 4:30pm <br />FAX 58~-7948 <br /> <br />PERMIT NO: ~? <br />Date: <br /> <br />Issued by: <br /> <br /> PLUMBING PERMIT APPLICATION <br />P/ease complete all Sections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br />TAX ACCOUNT NO. <br />'_°_7'D"SS <br /> CITY ~ <br /> PROPERTY OVv3qER <br /> <br /> OWNER'S <br />~PHONE g <br /> <br /> PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT <br /> STARTED WITHIN lg0 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br /> Property Owner (please print) <br /> <br /> Mailing Address <br /> <br /> Cily, 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 SCHEDULE (Complete and en~r total in 5-Al b~low) <br /> <br />RESIDENTIAL ~ COMMERCIAL {'I USE: <br /> NEW ~ ALTERATION [~ ADDITION ~ RELOCATION ['[ <br /> <br />BASE FEE Assessed on all applications $20.00 <br /> (Exception: Water/Sewer Line Applications w/no fixtures) <br /> <br />ARIL~ DRAIN INTERCEPTOR <br />BACKFLOW PREV DEVICE LAUNDRY TUB <br />BATHTUB RECEPTOR <br />BIDET SHOWER <br />CATCH BASIN ;~- SINK <br />CLOTHES WASHER TROUGH DRAIN <br />DENTAL UNIT TUB/SHOWER <br />CUSPIDOR URINAL <br />DRINKING FOUNTAIN WATER CLOSET <br />FLOOR DRAIN WATER HEATER <br />OTHER HO~ b~ b$ ~ WET BAR <br /> <br />Total g Fixtures x $10.00 <br /> <br />=$ <br /> <br />=$ <br /> <br />Lawn vacuum breaker / sprinkler system -- x $4.50 <br /> <br /> Residential: First100 ft., or fraction thereof x$20.00 =$ <br /> Foreaaddnll00 ft Up to 50O feet --. x$15.00 =$ <br /> Commercial: First 100 ft. Or fraction tl~reof x $25.00 = $ <br /> For ea addn1100 feet x $15.00 = $ <br /> <br /> Residential: First 100ft. or fi'action thereof x$30.00 =$ <br /> For ea addnl100 t~ Up to 500 feet __ x$15.00 =$ <br /> Commercial: First 100 ft. Or fraction thereof x $30.00 = $ <br /> For ea addn1100 feet x $15.00 = $ <br /> <br /> Residential: First 100ft. Or fraction thereof x$30.00 =$ <br /> Foreaaddnl 100ft. Up to S00 feet __ x$15.00 =$ <br /> Commemial: For 100 ft. Or fmetion thereof x $30.00 = $ <br /> For ea 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 /> <br />~ # of Labals N/C <br />(For New Single Family Dwellings Only) <br /> <br />5. FEES <br /> Al. Enter total of fees fi'om Sec. #4 <br /> A2. Add 5% surcharge (,05 x Al) <br /> <br />B. Enter 25% of line A 1 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 />Sub~ota] $ <br /> <br />TOTAL AMOUNT DUE <br /> <br />MC 15-45 7/97 <br /> <br /> <br />