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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 lnspeetion Line 373-4427 <br />Office: phone 588-S147 8:00am - 4:30pm <br />FAX 5~8-7948 <br /> <br /> PLUMBING PERMIT APPLICATION <br />P/ease complete afl Sections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br /> °"n°o ss <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT <br />STARVED WITHIN lg0 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSFENDED FOR 150 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />Plumbing Contractor <br /> <br />Mailing <br />Address <br /> <br />cit~ <br /> <br />PHONE <br /> <br />FAX <br /> <br />PLUMBING BOARD NO. <br /> <br />CONTRACTORS BOARD <br />REGISTRATION NO. <br />JOUR.NEYMANS <br />PLUMBERS NO. <br /> <br />CON'I3L~CTOR'S SIGNATURE <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br /> Pwperty Owner (p/ease print) <br /> <br /> Mailing Address //~e/.. 1~ [/'{L <br /> C~y, State, Zip <br /> <br />Agent's Signature <br /> <br />3. PLAN REVIEW SECTION <br /> <br /> Marion County does not require a plan review, <br />I 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 />MC/5]45 ;'/97 <br /> <br />PERMIT NO: <br />Date: <br /> <br />Issued by: <br /> <br />4. FEE SCHEDULE (Cora~le~ av~ ~ter u~l ~ S-Al ~w) <br />~SIDENTIAL ~ COMMERCIAL ~ USE: <br /> <br /> ~w ~ ~oN ~ ~omo~ ~ ~A~O~ ~ <br /> <br />B~E ~E ~ on ~1 ~pli~o~ $20.~ <br /> (E~e~ion: W~cw~ Line Appli~ w/no fi~s) <br /> <br />~TURES OTY OTY <br />AREA DRAIN INTERCEPTOR <br />BACKFLOW PREV DEVICE LAUNDRY TUB <br />BATHTUB ~PTOR <br />BIDET SHOWER <br />CATCH BASIN SINK ~ <br />CLOTHES WASHER TROUGH DRAIN <br />DENTAL UNIT TUB~HOWER <br />CUSPIDOR URINAL <br />DRINKING FO UNFAIN WAFER CLOSET II <br />FLOOR DRAIN WATER HEAFER <br />OTHER WET BAR <br /> <br /> To~ai # Fixates x $10.00 =$ <br />Lawn vacuum breaker / sprinkler system -- x $4,50 = $__ <br /> <br /> Residential: First 100 ft., Dr fraction timeof x $20.00 = $__ <br /> Foreaaddnll00ftUptoS00feet __ x$15.00 --$__ <br /> Commercial: First 100/k Or fraction the~of x $25.00 = $ <br /> Foreaaddnl 100 feet x$15,00 =S <br /> <br /> Residential: Firs~ 100 ff. Dr fraction thereof x $30.00 = $ <br /> For ea addn1100 {L Up to $00 f~t __ x $15.00 <br /> Commetclal: First 100 fi. Or fraction thereof x $30.00 ~ $ <br /> For en addal [00 feet x $15.00 = $ <br /> <br />STORM I)RAINg <br /> P-~sJdentin]t First ] 00 ft. Ot fracfum th~i'~of x $.30.00 ~ $ <br /> Foreaaddnll00fl. Up to SOO feet -- x$15.00 ~$__ <br /> Commercial: For 100 ~. Or traction thereof x $30.00 - $ <br /> Foreaaddn[ 100 feet x$15.00 ~$ <br /> <br /> ~$ <br /> <br />MINOR INSTALLATION LABELS x $50.00 <br />(Pack of 10 labels ~ $5.00 each, sold only to Plumbing conuaOors) <br />~ # of Labels N/C <br />(For New Single Family Dwellings Only) <br /> <br />5. FEES <br /> Al. Enter total of fees from Sec,/$4 <br /> A2. Add $% surcharge (.05 x Al) <br /> <br />B. Enter 25% of line Al for pMn Revlew <br /> (Al + .25), if required <br />C. [nvestlgatico Fee (if required) <br />D. Reinspection Fe~ ($25.00) <br /> <br />Receipt No. __ <br /> <br />TOTAL AMOUNT DUE <br /> <br /> <br />