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MARION COUNTY <br /> PERMIT NO: <br />[ I BUILDING INSPECTION DMSION <br />FOR CITY VALIDATION 3150 Lancaster Dr. NE- Suite C <br /> <br /> Received By: Salem. Oregon 97305-1398 Date: <br /> <br />IDate: 24 HR Inspection Line 373.4427 <br /> Office: phone 588-5147 8:00am - 4:30pm Issued by: <br /> FAX 588-7948 <br /> <br /> PLUMBING PERMIT APPLICATION <br /> Please complete all Sections, I through 5 4. FEE SCHEDULE (Complete and enter total in 5-Al below) <br /> <br /> RESIDENTIAL {'] COMMERCIAL ~ USE: <br /> 1. LOCATION OF INSTALLATION <br /> ~w 13 nLXeP. Ar~ON t'l AVVmOS C~ ~LOC~ZION <br /> TAX ACCOUNT NO. <br /> BASE FEE Assessed on all applieatinns $20.00 <br /> JOB Al)DP.ESS (Exception: Wator/Sewer Line Applications w/no fixtures) <br /> <br /> CITY FIXTURES OTY OTY <br /> AREA DRAIN INTERCEPTOR <br /> PROPERTY OWNER BACKFLOW pREV DEVICE -- LAUNDRY TUB <br /> BATHTUB RECEPTOR <br /> OWNER'S BIDET SHOWER <br /> PHONE # CATCH BASIN SINK <br /> CROSS STREET/DIRECTIONS CLOTHES WASHER [ TROUGH DRAIN -- <br /> DENTAL UNIT TUB/SHOWER <br /> PROJECT DESCRIPTION CUSPIDOR URINAL <br /> DRINKING FOUNTAIN WATER CLOSET <br />IPERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT FLOOR DRAIN WATER HEATER __ <br /> STARTED WITHIN 180 DAYS OF ISSUANCE OR IF OTHER WET BAR~..~ <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> Total#Fixtoresb x$10.00 =$ <br />2A. CONTRACTOR INSTALLATION ONLY Lawnvacuurabreaket/sprinklersystem x $4.50 <br /> <br /> Plumbing Contractor <br /> Residential: First l00 ft., Or fraction thereof -- x$20.o0 <br /> Mailing Foreaaddnl100ftUpto500feet __ x$15,o0 ~$__ <br /> Address Commercial: First 100 ft, Or fraction thereof x $25,O0 = $ <br /> For ca addnl 100 feet x $15.O0 <br /> <br /> Residential: First 100ff. Or fracfion thereof x$30.00 =$ <br /> For ea addnl 100 ft. Up to 500 feet __ x $15,00 <br /> PLUMBING BOARD NO. Commercial: First 100 ft, Or fraction thereof x $30.00 = $ <br /> CONTRACTORS BOARD Foreaaddnl 100feet __ x$15.00 =$__ <br /> REGISTRATION NO. STORM DRAINS <br /> JOURNEYMANS Residential: First Io0ft. Or fraction thereof x$30.00 =$ <br /> PLUMBERS NO. For ea addn[ 100 ft. Up to 500 f~et -- x $15.00 <br /> CONTRACTOR'S SIGNATURE Commercial: For 100 ft. Or fraction thereof x $30.00 -- $ <br /> For ea addnl IO0 fe~t x $15.00 = $ <br /> <br /> 2B. FOR OWNER INSTALLATIONS MINOR INSTALLATION LABELS x $50.00 ~ <br /> <br /> Property Owner (please print) (Pack of 10 labels ~ $5.00 each, sold only to Plumbing contractors) <br /> ~ # of Labels N/C <br /> Mailing Address (For New Single Family Dwellings Only) <br /> City, State, Zip <br /> 5. FEES <br /> Al. Enter total of fees from Sec. #4 $ <br /> Owner's Signature A2. Add 5% surcharge (.05 x Al) <br /> Subtotal $ <br /> Agent's Signature B. Enter 25% oflin~ Al for Plan Review <br /> (Al + .25), if requlred $ <br /> 3. PLAN REVIEW SECTION c. investigation Fee (if requireS) $ <br /> Marion County does not require a plan review, v. Re!nspection. Fee ($25.00)TOTAL AMOUNT DUE $$ <br /> We will provide plan review service if you complete R~ipt No. <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 /> <br />