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FOR CITY VALIDATION <br />Received By: <br /> <br />Date: <br /> <br /> MAR[ON COUNTY <br />BUILDING INSPECTION DIVISION <br /> 3150 Lancaster Dr. NE - Suite C <br /> Salem, Oregon 97305-1398 <br /> <br /> 24 HR luspection Line 373-4427 <br />Office: phone 58~S147 8:00am - 4:30pm <br />FAX ~88-7948 <br /> <br /> PLUMBING PERMIT APPLICATION I <br />Please complete all Sections, 1 through 5 <br /> I <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT I <br /> I <br /> STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br /> Plambing Contm~or <br /> <br />Mailing <br />Address Cit~ <br />::11 I- : <br /> <br />CONTRACTOR'S SIGNATDRE <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br />151o I--I Io I-I..CI ? Iol4, <br /> <br />Agent's Signa~e <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 />MC 15-45 7/97 <br /> <br />PERMIT NO: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />4. FEE SCHEDULE (Complete ~ ~t~r to~ in 5-Al ~ow) <br /> <br />RESIDENTIAL [~ COMMERCIAL ~ USE: <br /> <br /> NEW ~ ~ON ~ ~D~ ~ ~L~A~ON ~ <br /> <br />BASE ~E ~s~d on ~1 ~pli~io~ $20.~ <br /> (Ex~tion: Wmr~ewer Lin~ Appli~ w/no ~) <br /> <br />~IXTURES 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 TUB/SHOWER <br />CUSPIDOR URINAL <br />DRINKrNG FOUNTAIN WATER CLOSET I~ <br />FLOOR DRAIN WATER HEATER <br />OTHER WET BAR <br /> <br /> Total # Fixturesx $10.00 = $ <br />Lavmvacuumbc~d~r/sprinklersys~em __ x $4.50 =$__ <br /> <br /> Residential: Firstl00~.,Orframiontbercof -- x$20.00 <br /> Foreaaddnl 100 fi Up to S00 feet -- x$15.00 --$__ <br /> Commercial: First 100 IL or fraction thereof x $25.00 = $ <br /> F~ ea addnl 100 f~t x $15.00 = $ <br /> <br /> Residential: First 100 fl. or fraction thereof x $30.00 = $ <br /> For ea addnl 100 fL Up to 500 fe*t -- x $15.00 <br /> Commercial: First 100 fi. Or fraction thereof x $30.00 = $ <br /> For~aaddnl 100 f~t x$15.00 =$ <br /> <br />STORM DRAINS <br /> Residential: Fire 100 tL Or fraction tbegof x $30.00 = $ <br /> For ~t addnl 100 fL Up to 500 f~t __ x $15.00 <br /> Commemial: For 1190 f~. Or fragtion figreof x $30.00 = $ <br /> Forea addnl 100 feet x $15.00 = $ <br /> <br />MINOR INSTALLATION LABELS x $50.00 <br />(Pack of 10 labels ~ $5.00 ~ach, sold only to Plumbing ~ontractors) <br />~ # of Labels __ <br />(For New Single Family Dwellings Only) <br /> <br />N/C <br /> <br /> FEES <br /> Al. Enter tom[ of fee~ from See. #4 $ <br /> A2. Add 5*/* surcha~e (.05 x Al) $ <br /> Sub~l <br /> <br />B. Enter 25% of line A I ['or Plan Rcvi*w <br />(Al + .25), if required $ <br />C. Investigation F¢~ (if required) $ <br />D, R¢inspectlon Fee ($25.00) $ <br /> TOTAL AMOUNT DUE $ <br />Receipt No. <br /> <br /> <br />