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FOR CITY VALIDATION <br />Received By: <br /> <br /> MARION COUNTY <br />BUILDING INSPECTION DIVISION <br /> 3150 Lancaster Dr. NE - Suite C <br /> Salem, Oregon 97305-139g <br /> <br /> 24 HR Inspection Line 373-4427 <br />Office: phone 588-5147 8:OOam - 4:30pm <br />FAX ~7948 <br /> <br />PERMIT NO: <br /> <br />Date: <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 /> crrv ~c/gO~t-~, <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 IlO DAYS. <br /> <br /> 2.4,. CONTRACTOR INSTALLATION ONLY <br />IPlumbing Contractor <br /> <br />] Mailing <br />· Address <br /> <br /> Civ/ <br />:111 I-I - <br /> <br />CONTRACTOR'S SIGNATURE <br /> <br />:B. FOR OWNER INSTALLATIONS <br /> <br /> ci~, s~ zi0 ~O~L~, <br /> P~ Islo I-I lYIol-lfl?lol <br /> <br /> Agent's <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 (Compl~ aaa ~a~r total in S-Al <br />RESIDENTIAL ~ COMMERCIAL ~ USE: <br /> <br /> NEW ~ ~ON ~ ~omoN ~ ~A~ON <br /> <br />B~E ~E A~s~d on ~1 ~pli~s S20.~ <br /> (Ex~ti~: ~/Se~ Li~ A~li~fi~ w/no f~) <br /> <br />~ OYY OTY <br />AREA 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 />DR/NKING FOUNTAIN WATER CLOSET ~ <br />FLOOR DRAIN WATER HEATER <br />OTHER WET BAR <br /> <br /> Total#Fixtures x $10,00 --$ <br />Lawnvacuumtneaker/sprinklersystom -- x $4,50 =S <br /> <br /> R~identia]: Firstl00R. or fraction thoreof -- x$20.00 =$ <br /> For ea addn1100 ft Up to 500 feet -- x$15,00 =S <br /> Comme~ial: Flwt 100 IL Or fiaction tho'~f x $25.00 -- $ <br /> For ga addn[ 100 feet x $15.00 = $ <br /> <br /> Residential: First 100ff. Orfractlon0acreof x$30.00 =$ <br /> For ea addnl l00 fL Up lo $00 fee~ -- x$15.00 =$ <br /> Comme~cinl: First 160 tL Or fra~inn ther~f x $30.00 = $ <br /> For ga addnl 100 f~ x $15.00 = $ <br /> <br />STORM DRAINS <br /> R~sidentia]: First 100 fi. Or fraction thereof x $30.00 = $ <br /> Forgaaddnl [00R. UptoS00 feet x$15.00 =$ <br /> Commercial: For 100 fL Or fiacfon ~hegof x $30.00 = $ <br /> For ga ~ddn[ 100 fee~ x $15.00 = $ <br /> <br /> =$ <br /> <br />MINOR INSTALLATION LA~ELS x $50.00 <br />(Pack of 10 inb~ls @ $5.00 ~a~h, sold only to Plumbing <br /> <br />~ # of Labeb <br />(For N~v Single Family Dwellings O~ly) <br /> <br />N/C <br /> <br />5. FEES <br /> Al. Enter total of fees ~om Sec. #4 <br /> A2. Add 5% surcharge (.05 X Al) <br /> <br />B. Enter 25% of line Al for Plan Review <br /> (Al + .25), if requlred <br />C. [nvestigati~ F~ (if required) <br />D, Reinsp~ction Fee <br /> <br />Receipt No. <br /> <br />Sutn~al <br /> <br />TOTAL AMOUNT DUE <br /> <br />MC 15-43 7/97 <br /> <br /> <br />