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FOR CITY VALIDATION <br />Received By: <br /> <br />Date: <br /> <br /> MARION COUNTY <br />BUILDING INSPECTION DMSION <br /> 3150 Lancaster Dr. NE. Suite C <br /> Salem, Oregon 97305-1398 <br /> <br /> 24 HR Inspection Line 373-4427 <br />Office: phone .~-$147 $:00am - 4:30pm <br />FAX 588-7~48 <br /> <br /> PLUMBING PERMIT APPLICATION <br />Please complete all Sections, ~ through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br /> - D <br /> <br /> I 10 Io I-I 1 171-171 1 1o <br /> <br /> PRO~ DESC~ON <br /> <br />PERI. TS ARE NON-TRANSFERABLE AND EXPIKE 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 /> <br />Plumbing Contractor <br /> <br />Mailing <br />Address City <br />::111 I-I - <br /> <br />CONTRACTOR'S SIGNATURE <br /> <br /> 2B. FOR OWNER INSTALLATIONS <br /> <br />,~. Mailing Address ~O <br /> <br />~ Ph.e I~101ol-I~lavL-I?l~l~lo <br /> <br />3. PLAN REVIEW SECTION <br /> <br /> Mar/on 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 />Date: <br /> <br />Issued by: <br /> <br />4. FEE SlJItEDULE (Complete and enmr to~l in 5-Al b~low) <br /> <br />RESIDENTIAL ~ COMMERCIAL p USE:. <br /> i, mw/~ ~LTE~A~ON ~ .~/amo~ [~ m~UecA'aO~ [~ <br />BASE FEE Assessed on all applicatinas $20.00 <br /> (Exception: Wat~£/Scwer Line Applioatiooz w/no fi.xiur~) <br /> <br />glX~gS OYY OTY <br />ARFA DRAIN INTERCEPTOR <br />BACKFLOW PREV DEVICE LAUNDRY TUB ~ <br />BATHTUB RECEPTOR <br />BIDET SHOWER t <br />CATCH BASIN ,. __ SINK ~ <br /> <br />CUSPIDOR URINAL <br />DRINKING FOUNTAIN WATER CLOSET 7 <br />FLOOR DRAIN WATER HEATER ~ <br />(YrHER Wt~T BAR <br /> <br /> Total#Fixtures ~ x$10.00 =$__ <br /> <br />Lawnvacuumbreakcr/sprialdc~system -- x $4.50 <br /> <br /> Residential: Fitstl001t.,Orfractitmthereof __ x$20.00 =$__ <br /> For ca addnl 100 it Up to 500 feet __ x $15.00 <br /> Commercial: First 100 R, or fraction thereof x $25,00 = $ <br /> For ~ addal 100 feet x$15.00 --$ <br /> <br /> Rasiden~ial: First 100 ti. Or fraction thereof x $30,00 = $ <br /> For ca addnl 100 ft. Up ~o 500 f~et __ x $15,00 <br /> Commercial: First 100 ii. or fraction thereof x $30.00 = $ <br /> For caaddal 100 feet x$15.00 =$ <br /> <br />~TORM DRAINS <br /> Res[d~ttial: First 100 ff, Or fracdon thereof x $30,00 = $ <br /> Foteaaddal 100ii. Up ~o 500 feet __ x$15.00 --$ <br /> Commercial: For 100 ii. Or fraction thereof x $30.00 = $ <br /> For ca addn[ 100 feet x $15.00 = $ <br /> <br /> --$ <br /> <br />MINOR INSTALLATION LABELS x $50.00 <br />(Pack of 10 labels ~ $5.(~0 e,~h, sold only to Plumbing cona~actors) <br /> <br />~ # of Labels __ <br />(Per New Single Family Dwellings Only) <br /> <br />N/C <br /> <br />FEES <br />Al. Enter total of fees from Sec. <br />A2. Add 5% surcharge (.05 xA1) <br /> <br />Subtotal <br /> <br />B. En~r 25% of line A1 far Plan Review <br />(Al + .25), if required $ <br />C. lrtveatigafio~ Fe~ (if mquil~d) $ <br />D. Reinspection Fee ($25.00) $ <br /> TOTAL AMOUNT DUE $ <br />Receipt No. <br /> <br />MC 15-45 7/97 <br /> <br /> <br />