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FOR CITY VALIDATION <br />Received By: <br /> <br />Date: <br /> <br /> MARION COUNTY <br />BUILDING INSPECTION DIVISION <br />3150 Lancaster Dr. NE * Suite C <br /> Salem, Oregon 97305-1398 <br /> <br /> 24 HR Inspection Line 373-4427 <br />Office: phone $88..5147 8:00am - 4:30pm <br />FAX 588-7948 <br /> <br /> PLUMBING PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br /> , <br />I CITY j~t.}xL"/g'y~---- <br /> <br /> CROSS STREET/DIRECTIONS <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT <br />STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br /> Mailing <br /> <br /> ~OIS~TION NO. <br /> <br />2B. ~R O~R INSTALLATIONS <br /> <br /> P~ Owner (please print) <br /> Mailing Add,ss <br /> <br /> City, State, Zip <br /> <br /> Owner's Signature <br /> <br /> A$ent's Signatur~ <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 />PERMIT NO: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />4. FEE SCHEDULE (Complete and ~nt~r total in S-Al beinw) <br />RESIDENTIAL ~ COMMERCIAL ~ USE: <br /> <br /> NEW ~ ALTERATION f~ ADDITION ~ RELOCATION [~ <br /> <br />BASE FEE Assessed on all applications $20.00 <br /> (Exception: Water/Sewer Line Applications w/no fvaures) <br /> <br /> ~ OTY OTY <br />AREA DRAIN INTERCEPTOR <br />· .-BAC KFLOW 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 />DRINKING FOUNTAIN WATER CLOSET <br /> FLOOR DRAIN WATER HEATER 4 <br /> OTHER WET BAR <br /> <br /> Tot~#F~s ~ x$1o,oo =*qO, <br /> Lawn vacuum breaker / sprinkler system __ x $4.50 -- $ __ <br /> <br /> Residential: First l0O ff., or fraction thercof -- x$20.00 =$__ <br /> For ca addn1100 fl Up to 500 feet x $15.00 = <br /> Commercial: First 100 fc Or fraction thereof ~ x $25.00 = <br /> For ca addal 100 feet x $15.00 = $ <br /> <br /> Residential: First t00 ~. Or fraction t~rcof x $30.00 = $ <br /> Foreaaddnll00ft. Up to S00 feet -- x$15.00 =$__ <br /> Commercial: First 100 fc Or fraction thereof I x $30.00 = $ <br /> For ca addnl 100 l~et x $15.00 = $ <br /> <br /> STORM DRAINS <br /> Residential: First 100 iL Or fraction thereof x $30.00 = $ <br /> Foreaaddall00tt. Up to 500 feet __ x$15.00 =$__ <br /> Commercial: For 100 ff. Or fi'action thereof x $30.00 = $ <br /> Foreaaddal 100 feet x$15.00 =$ <br /> <br /> =$ <br /> <br />MINOR INSTALLATION LABELS x $50.00 <br />(Pack of 10 labels ~ $5.00 e~ch, sold only to Plumbing contractors) <br /> <br />~ # of Labels <br />(For New Single Family Dwllings Only) <br /> <br />N/C <br /> <br />5. FEES <br />A 1. Enter total of fees from See. #4 $ <br />A2. Add 5% surcharge (.05 x Al) $ ~ <br /> <br /> I <br /> <br />MC 15-45 7/97 <br /> <br /> <br />