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FOI~ CITY VALIDATION <br />Received By: ~ <br />Date: ~ ,~//~ ,~dO <br /> <br /> PLUMBING PERMIT APPLICATION <br />Please complete all Sections, 1 through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br /> TAX ACCOUNT NO. <br /> <br /> JOB ADDRESS /D ~ <br /> CITY <br /> <br />OWNER'S <br /> <br />CROSS STREET/DIRECTIONS <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT <br />STARTED WITHIN lg0 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br />Plumbing Contrac~)r <br /> <br />Mailing <br /> <br />PLUMBERS NO. <br /> <br />CONTRACTOR'S SIGNATURE <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 5B and submit two (2) sets of plans and <br /> specifications with this application. <br /> <br />MC 15-45 7/97 <br /> <br /> MARION COUNTY <br />BUILDING INSPECTION DIVISION_ / PERMIT NO: <br /> 3150 Lancaster/3r. NE- Suite <br /> Salem, Oregon 97305-1398r~.[~ Date: <br /> 24 HR Inspection Line 3734427 <br /> Office: phone 588-5147 8:OOamL~o~p~ 5 <br /> 1995 Issued by: <br /> FAX S88-7948 <br /> MARION COUNTY <br /> <br /> (Complet~ and enter total in 5-Al below) <br />RESIDENTIAL ~COMMERCIAL ~ USE: <br /> ~mw ~A~TIO~ ri ~DmO~ ~ ~.~OC^~O~ <br />BASE FEE Assessed on all applications ~ <br /> (Exception: Water/Sewer Line Applications w/no fixtures) <br /> <br />FIXTURES OTY OTY <br />AREA DRAIN INTERCEPTOR <br />BACKFLOW PREV DEVICE LAUNDRY TUB <br /> <br />BATHTUB RECEPTOR <br />BIDET SHOWER <br /> ~ -sr~c <br />CLOTHES WASHER TROUGH DRAIN -- <br />DENTAL UNIT TUB/SHOWER <br />CUSPIDOR URINAL <br />DRINKING FOUNTAIN WATER CLOSET -- <br />FLOOR DRAIN WATER HEATER -- <br />OTHER WET BAR <br /> <br /> Total # Fixtures x $10.00 = $ <br />Lawn vacuum breaker / sprinkler system ~r x $4.50 = $ <br /> <br /> Residential: First 100 fi., Or fraction thereof __ x $20.00 = <br /> ForeaaddnllO0flUptoS00feet -- x$15.00 =$__ <br /> Commercial: First 100 fi. Or fraction thereof x $25,00 = <br /> For ea addnl 100 fe~t x $15.00 ~ $ <br /> <br /> Residential: First 100 ii. Or fiaetion thereof x $30.00 ~ $__ <br /> For ca addnl 100 ii. Up to 500 feet __ x $15.00 <br /> Commercial: First 100 ii. Or fraction thereof x $30.00 ~ $__ <br /> For ea Mdn1100 feet x $15.00 = $ <br /> <br />STORM DRAINS <br /> Residential: First 100 ii. Or fraction thereof -- x $30.00 = <br /> Foreaaddnl 100ii. Up to S00 feet __ x$15.00 =$__ <br /> Commerelak Fo~ 100 ii. Or fraction thereof x $30.00 = $__ <br /> For eaaddnl 100 feet 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 />]~I~.[~ # of Labels -- <br />(For New Single Family Dwellings Only) <br /> <br />N/C <br /> <br />FEES <br />A 1. Enter total of fees from S~. #n $ <br />A2. Add 5% surcharge (.05 x A I ) $ <br /> Subtotal $ <br />B. Enter 25% of line A1 for Plan Review <br />(Al + .25), if required /.f~/.-..~.~. $ ~.~r <br />C. Investigation Fee (if required) $ <br />D. Reinsp~ction Fee ($25.00) $ <br /> TOTAL AMOUNT DUE S <br /> <br /> <br />