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,], FOR CITY VALIDATION <br /> <br /> Date: <br /> <br /> MARION COUNTY <br />BUILDING INSPECTION DIVISION <br /> 3150 Lancaster Dr. NE - Suite C <br /> Salem, Or~gnn 97305-1398 <br /> <br /> 24 HR Inspection Line 37~.4427 <br />Office: phone 588-S147 8:00am - 4:30pm <br />FAX 588-7948 <br /> <br />Date: <br /> <br />Issued by: <br /> <br /> PLUMBING PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br /> ,oB, DRESSS /3' I l¼ <br /> <br /> I I I' I-I I'1 I-I I I I <br /> C~OSS ST~T~[~CTIONS <br /> <br />PROJECT DESCRIPTION <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT J <br /> STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> I <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br />Plumbing Contractor <br /> <br /> Mailing <br /> Address <br /> <br /> CONTRACTOR'S SIGNATURE <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br />Property Owner (please print} <br /> <br />Mailing Address <br /> <br />Cio, State, Zip <br /> <br />Owner's Signature <br />Agent's Signature <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 />4. FEE SCHEDULE (Complete and enter total in 5-Al below) <br /> <br />RESIDENTIAL ~ COMMERCIAL {~ USE: <br /> NEW I~1 ALTERATION ~ ADDmON I~[ RELOCATION ['1 <br />BASE FEE Assessed on all applications $20.00 <br /> (Exception: Water/Sewer Line Applications w/no f~xtures) <br /> <br />FIXTURES OTY OTY <br />AREA DRAIN INTERCEPTOR <br />BACKFLOW PREV DEVICE LAUNDRY TUB ~ <br />BATHTUB RECEPTOR <br />BIDET SHOWER ] <br />CATCH BASIN SINK / J[.V, <br /> I <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 />Totai# Fixtums _~ x $10.00 = $_~_1a <br /> <br />Lawn vacuum breaker / sprinkler system __ x $4.50 = $ <br /> <br /> Residential: First ]00fl.,Orfracfionthereof x$20.00 =$ <br /> Foreaaddail00ftUptoS00feet -- x$15.00 =$ <br /> Commemial: First 100 fi. Or fra~ien thereof x $25.00 = $ <br /> For ea addn1100 feet x $15.00 = $ <br /> <br /> Residential: First 100 fi, Or fraction thereof x $30,00 = $ <br /> Foreaaddail00fi. Up to S00 feet -- x$15,00 =$__ <br /> Commercial: First 100 fi, Or fraction thereof x $30,00 = $ <br /> For ea addai 100 feet x $15,00 = $ <br /> <br />STORM DRAINS <br /> Residential: First 100 R. Or fiaetion thereof x $30.00 = $ <br /> Foreaaddnl 100fl. Up to SOO feet -- x$15.00 =$__ <br /> Commercial: For 100 fl, Or fraction thereof x $30.00 = $ <br /> For ea addnl 100 feet x $15.00 = $ <br /> <br /> =$ <br /> <br />MINOR INSTALLATION LABELS x $50.00 <br />(Pack of 10 labels ~ $5.00 each, sold only m Plumbing contractors) <br /> <br /> # of Labels <br /> (For New Single Family Dwellings Only) <br /> <br />N/C <br /> <br />5. FEES <br />Al. En~ ~ of ~s ~m S~. #4 $ <br />~.A~5%sureha~e(.05xAl) $ <br /> <br />B. Enter 25% of line Al for Plan P~vie~v <br /> (Al + .25), if required <br />C. Investigation Fee (if requlred) <br />D. Reinspection Fee ($25,00) <br /> <br />Receipt No. __ <br /> <br />TOTAL AMOUNT DUE <br /> <br />MC 15-45 7/97 <br /> <br /> <br />