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MARION COUNTY <br />BUILDING INSPECTION DIVISION <br />3150 Lancaster Dr. NE - Suite C <br /> Salem, Oregon 97305-1398 <br /> <br /> 24 HR l~spection Liae 373.4427 <br />Offie*: phone 588-~147 8:00sm - 4:30pm <br />FAX ~8-794~ <br /> <br /> PLUMBING PERMIT APPLICATION <br />Please complete afl Sections, 1 through 5 <br /> <br />1. lOCATION OF INSTALLATION <br /> <br />TAX ACCOUNT NO. <br /> <br /> :OR, <br /> <br /> Ifle/ l-I l lq I'1 <br /> <br /> ~t~ ' <br /> <br /> ST~ ~ IS0 ~*YS O~ mSU~C~ O~ <br /> WO~ IS SUS~ND~ FO~ 1~9 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br />3, PLAN REVIEW SECTION <br />IMm'ion 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 0f plans and <br /> specifications with this application. <br /> <br />AREA DRAIN <br />BACKFLOW PREV DEVICE <br />BATHTUB <br /> <br />CATCH BASIN <br />CLOTHES WA$1~.R <br /> <br />DRINKING FOUNTAIN <br />FLOOR DRAIN <br />OTHER <br /> <br />4. FEE SCliEDULE (comp~ ~t ~ ~ in S-Al below) <br />RESIDENTIAL ~] COMMERCIAL [~ USE: <br /> <br /> N~W CJ Auma~ON ~ a~omo~ ~ PmCoea'no~ <br /> <br />BASE FEE Ass~sed on all applications $20.00 <br /> (Exception: Water/Sewer Line Applications w/no fixtures) <br /> _C~ INTERCEPTOR OTY <br /> LAUNDRY TUB <br /> RECEPTOR <br /> SHOWER <br /> SINK <br /> T TROUOH DRAIN <br /> TUB/SliOWER <br /> URINAL <br /> WATER CLOSET <br /> wA'mR.~_,u~r~ <br /> WBT BAR <br /> <br /> To~l # Fixtetes ~ x $10.00 = <br />Lawn vacuum breaker / sprinlder system x $4.50 <br /> <br /> Resident/ah First 100 t~., Or fraction thereof x $20.00 = <br /> Foreaaddrd 100flUptoS00fe~ __ xSH.00 =$ <br /> Commercial: First 100 ~ Or fraction thereof x $2~.00 = <br /> Foreaadda! 100 f~t x$1~.00 =$ <br /> <br /> R~4Aeat~l: Fi~s~,100fcOr fractio,a0ael~ff x$~0.00 =$ <br /> Foreaaddnl 10Ofl. Upto$00f*~ __ x$15.00 =$ <br /> Commerci*h First 100 ~C Or fraction 0lereof x $30.(10 = $ <br /> For ea addnl 100 feet x $I$.00 = $ <br /> <br /> Realdent/al: First 100fl. Drfracficnflmreof x$30.00 =$ <br /> Fm ea add~l 100 ~. Upw 500 f~t x $3!L~0 <br /> Commerclah For 100 fl. Or fraci/on thereof x $30.00 = $ <br /> For ~ add,.[ I(~ fe~ x $35.00 -- $ <br /> <br />MINOR INSTALLATION LABELS x $50.00 = S <br />(Pack of 10 labds ~ $5.00 eacl'~Old only to PlU~abing <br />~ # of L~0eh <br />flor No~, Single Family Dwellings Only) <br /> <br />FEES <br /> <br />Receipt No. __ <br /> <br />TOTAL AMOUNT DUE <br /> <br />MC 15-45 7/97 <br /> <br /> <br />