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FOR CITY VALIDATION <br />IReceived By: <br /> Date: <br /> <br /> MARION COUNTY <br />BUILDING INSPECTION DMSION <br />3150 Lancaster Dr. NE - Suite C <br /> Salem, O~gon 97305-1398 <br /> <br /> 24 HR I~ap~etion Line 373-4427 <br />Otllce: phone 588-5147 8:00am - 4:30pm <br />FAX ~88-7948 <br /> <br />Date: <br /> <br />Issued by: <br /> <br /> PLUMBING PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br /> ~OS~D~SS ~:~0 ~ ~.CcPOP-~ ~, ~ <br /> c~qg0~, ~~ <br /> <br /> ~oss s~r~o~s ~/q <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 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br />plumbing Corm'actor <br /> <br />Mailing <br />Addr~ City <br /> <br />?LU, INo o No. III'-~ III <br /> <br />~iSTRA~ON NO. t I I I I I I <br />JOURNEYMANS .- JB <br /> Illl Ill <br />CONTRACTOR'S SIGNATURE <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br />3. PLAN REVIEW SECTION <br />lMarion 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 (Complet~ ae~ ~nter total in 3-Al b~low) <br /> <br />RESIDENTIAL ~ COMMERCIAL ~ USE: <br /> <br /> ~w ~ ~HON ~ ~DmON <br /> <br />BASE ~E AS~ on all ~pli~fio~ ~-~ <br /> (Exertion: Wa~$~er Line Appli~ <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 UN1T -- TUB/SHOWER <br />CUSPIDOR URINAL <br />DRINKING FOUNT. MN WATER CLOSET ~ <br />FLOOR DRAIN WATER HEATER -- <br />OTHER WET BAR <br /> <br />To~ # Fixtu~ <br /> <br />x $10.00 <br /> <br />x $4.50 <br /> <br />Lawn vacuum br~ker / sprinkler system <br /> <br /> Residential: Firstl00tL, or fraction tbeveof -- x$20,00 =$__ <br /> For ~a addnl 100 fiUp to 500 f~'t x$15.00 <br /> Commeccial: First 100fi. or f~ractiontbereof -- x$25,00 <br /> For ca addn1100 fe~t __ <br /> <br /> Resid~atial: Firstl001LOrfraetionthcreof -- x$30.00 =$__ <br /> Foreaaddnl 100fi. UptoS00feet -- x$15.00 =$__ <br /> Comme~ial: First 100 l~. or fraction the~of -- x$30.00 =$__ <br /> For ca addn1100 feet -- x$15.00 =$__ <br />STORM URAINS <br /> Residential: First 100 fc or fraction thereof -- x$30,00 =$ <br /> ForeaaddMI00i~.UptoS00feet __ x$15.00 =$ <br /> Commercial: For 100 fi. Or fraction thereof x $30.00 -- $ <br /> For~aaddnl 100 f~et -- 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 />D3~ # of Labels N/C <br />(Fox'New Single Family Dwellings Only) <br /> <br />5. FEES <br />Al. Ent~r to~al of feea fiom Sec. #4 $ <br />3,2. Add 5% surcharge (.05 x Al) $ <br /> <br />B. Enter 25% of line A1 for Plan Review <br /> (Al + .25), if requi.~t <br />C. Investigation Fee (if mqulred) <br />D. Reinspection Fee (S25.~0) <br /> <br />Receipt No. <br /> <br />TOTAL AMOUNT DUE <br /> <br />MC 15-45 7/97 <br /> <br /> <br />