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IFOR CI'TY VALIDATION <br /> Received By: <br /> <br /> Date: <br /> <br /> /~u~RION COUNTY <br />BUILDING INSPECTION DIVISION <br />3150 Lanca~er Dr. NE - Suite C <br /> Salem, Oregon 97305-1398 <br /> <br /> 24 HR lasp~ction Line 373-4427 <br />Office: phone ~g8-5147 8:00am - 4:30pm <br /> <br />Da~e: <br /> <br />Issued by: <br /> <br /> PLUMBING PERMIT APPLICATION <br />P/ease cqmplete all Sections, 1 through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br /> JOSnDDgESS go ' <br /> <br /> I-I b bI-I I Iol <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT <br />ST?d~,TED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR IS0 DAYS, <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />Plumbing Conm~c~r <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br /> I-I l lol-I l lol <br /> <br /> I <br /> ~em's Sirra <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 atrJ e~r ~.al in 5-A! ~low) <br />RESIDENTIAL ~ ~ERC~L ~ USE: <br /> <br />BASE FEE A~s~d on ~l ~pli~o~ $20.~ <br /> (Ex~pti~: W~ Line Appli~t~ w~o ~) <br /> <br />~ OTY OTY <br />AREA DRAIN INTERCEPTOR <br />BACKFLOW PREV DEVICE LAUNDRY TUB <br />BATHTUB RECEPTOR <br />BH)ET SHOWER <br />CATCH BASIN -- SINK <br />CLOTHES WASHER TROUGH DRAIN <br />DENTAL UNIT TUB/SHOWER <br />CUSPIDOR URINAL <br />DRINKING FOUNTAIN ~ATER CLOSET <br />FLOOR DRAIN WATER HEATER <br />OTHER WET BAR. <br /> <br /> Total # Fixt~r~ x $10,00 =$ <br />Lawn vacuum breaker / slninkler sy~em x $4.50 = $ <br /> <br /> Residential: First 100 fi., Or fraction thc~of __ x $20.00 = $ <br /> For ca addn[ 100 fl Up to 500 feet x $15.00 --$ <br /> Commercial: First 100 fi. Or frac~oa thereof x $25.00 = $ <br /> For ea addn[ 1~0 feet x St5.00 = S <br /> <br /> Residenfiah First 100 fi. or fraction thereof x $30.00 -- $ <br /> For ea addn1100 fl. Up to 500 fce~ x $15.00 <br /> Commercial: First 100 R. Or fraction thereof x $30.00 = $ <br /> For eaaddn1100 f~t x$15.00 =$ <br /> <br />STORM DRAINS <br /> Residemig: Fi~ 100 ~. Or frac~on therwf x $30.00 = $ <br /> For ea addnl 100 fl. Up to 500 fee~ -- x $1i00 <br /> Commercial: For 100 I~ Or fraction thereof x $30.00 = $ <br /> For ca a~dnl 100 feet x $15.00 <br /> <br />MINOR INSTALLATION LABELS x $50.00 = $ <br />(Pack of l0 labels ~ $5.00 each, sold only to Plumbing con~ns) <br /> <br />~,~,~ # of Labels N/C <br />(Fo~ New Single Family Dwellings Only) <br /> <br />5. FEES <br /> <br />B. Enter 25% of llne A1 for Plan Review <br /> (Al + .25), ff requ/red <br />C. Inve~.igation Fee (if required) <br />D. Reinspecti~ Fcc ($25.00) <br /> <br />TOTAL AMOUNT DUE <br /> <br />S <br />$ <br />S <br /> <br />S <br />$ <br />$ <br /> <br />MC t5-45 7/97 <br /> <br /> <br />