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FOR CITY VALIDATION <br />Received By: _ <br /> <br />Date: <br /> <br /> MARION COUNTY <br />BUILDING INSPECTION DIVISION <br />3150 L~caster 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 588-7948 <br /> <br />PLUMBING PERMIT APPLICATION I <br />Please complete all Sections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br /> ~o~ A~O~SS E::~ ~'~ <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 Ig0 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br /> plumbing Contractor <br /> <br />Mailing <br />Address <br /> <br />2B. FOR OWNER INSTALLATIONS <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 SB and submit two (2) se~s of plans and <br /> specifications with this application. <br /> <br />MC 15.45 7/97 <br /> <br />PERMIT NO: ~ <br />Da~e: <br /> <br />Issued by: <br /> <br />4. FEE SCHEDULE (comp~.~ and eater toal in 5-Al below) <br /> <br />RESIDENTIAL {~ COMMERCIAL {~ USE: <br /> <br />BASE ~E A~s~ on ~l ~pli~ $20.~ <br /> (Ex~pti~: W~/S~ Line A~li~i~ w/no f~) <br /> <br />FIXTURES OTY 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 TUBtSHOWER <br />CUSPIDOR URINAL <br />D~G FOUNTAIN WATER CLOSET ~ <br />FLOOR DRAIN WA'I~R I-W. ATER -- <br />OTHER WET BAR <br /> <br /> To~l # Fixtures x $10.00 = $ <br />Lawavacuumbreaker/sprlnklersystem -- x $4.50 =$ <br /> <br /> Resideatial: Firstl0Ofi.,Orfractionthen~of -- x$20.00 =$ <br /> For ea addn1100 fl Up to 500 feet -- x $15.00 <br /> Commercial; Fir~-t 100fi. or fra~iontlgreof -- x$25.00 --$ <br /> Foreaaddnl 100 feet -- x$15.00 -$ <br /> <br />R~idential: First 100 lt. Or fraction a~-n~,f x $30.00 -- $ <br /> For~taddnll0Ofl. UptoS00f~t -- x$15.00 --$ <br />Commerdal: First 100 lt. Or fra~ion tlxa'~of __ x $30.00 <br /> For ea addnl 100 f~l -- x $15.00 = $__ <br />STORM DRAINS <br />Residential: Fkst 100ii, orfrac/ion~hereof -- x$30.00 ~$__ <br /> For e~ addn1100 Ii. Up to ~00 fee~ -- x $1~.00 <br />Commercial: For 100 1~ Or fraction the~of __ x $30.00 = S__ <br /> Foreaaddn1100 feet x$15.00 =$__ <br /> <br />MINOR INSTALLATION LAEELS __ x$50.00 =$__ <br />(Pack of l0 labels ~ $5.00 each, sold only to Plumbing contractors) <br /> <br />~ ~ ~}~ ~ ~ ~[ ~ ~ ~ # of Labels N/C <br />(For New Single Family Dwellings Only) <br /> <br />5. FEES <br />A l. Enter total of f~e~ from S~. #4 $ <br />A2. Add 5% su~harge (.05 X A I ) $ <br /> <br />B. Enter 25% of [ir~ A 1 fo~ Plan R~view <br /> (Al + .25), if required <br />C. Inveatigation Fee (if r~lulr~d) <br />D. Reinsp~tion Fe~ ($25.00) <br /> <br />Receip~ No. <br /> <br />TOTAL AMOUNT DUE <br /> <br /> <br />