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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 8:00am - 4:30pm <br />FAX 588-79,18 <br /> <br /> PLUMBING PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br /> I l lxl-1 lTIrl-I)Izl il= <br /> CROSSST~ET~I~CTIONS ~r~0~ ~ ~ ~ <br /> <br /> STARTED W]TH~ I~0 DA~S OF ISSUANCE OR IF <br /> I <br />~ WO~ IS SUSPEND~ ~0~ 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br />Plumbing Con~ractor <br /> <br />Mailing <br />Address City <br /> <br />PHONE ~ ~ <br /> <br />CONTRACTOR'S SIGNATURE <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br />3. PLAN REVIEW SECTION <br /> <br /> Marion County does not require a plan review. <br /> We wi11 provide plan review service if you complete <br /> Section SB and submit two (2) sets of plans and <br /> specifications with this application. <br /> <br />MC 15-45 7/97 <br /> <br />PERMIT NO: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />4. FEE SCHEDULE (Complete and enter total in 5-Al below) <br />RESIDENTIAL ~ COMMERCIAL [~ USE: <br /> <br /> NEW I'1 ALTERATION ~ ADDITION [~ RELOCATION fl <br /> <br />BASE FEE Assessed on all applications $20~00 <br /> (Exception: Water/Sewer Line 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 # Fixturesx $10.00 <br />Lawn vacuum breaker / sprinkler system -- x $4,50 <br /> <br />WATER LINES <br /> Residential: First 100 ff, Or fraction thereof -- x $20.00 <br /> For ea addn[ [00 il Up to 500 feet -- x $15.00 <br /> Cerumen:iai: First 100 ff. Or fraction thereof x $25,00 <br /> For ea addn1100 feet I x $15.00 <br /> <br /> Residential: First 100 ft, Or fraction thereof x $30.00 <br /> For ea addn1100 ff. 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 />STORM DRAINS <br /> Residential: First 100 ff. Or fraction thereof x $30.00 <br /> For ea addnl 100 ff. Up to 500 feet -- x $15.00 <br /> Commercial: For I00 ft. Or fraction thereof x $30.00 <br /> For ea addn1100 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 />~&~L~.~ # of Labels <br />(For New Single Family Dwellings Only) <br /> <br />N/C <br /> <br />5. FEES Al. Enler fetal of fees from $~c. #4 <br /> A2. Add 5% surcharge (.05 x Al) <br /> <br />B, Enter 25% of line A1 for Plan Review <br /> (Al + .25), if required <br />C. Investigation Fee (if required) <br />D. Reins@ec0on Fee ($25.00) <br /> <br />Receipt No. <br /> <br />Submml <br /> <br />TOTAL AMOUNT DUE <br /> <br /> <br />