PlumbingPermit Application

Building and Safety Division/Permit Application CenterCity Hall / 555 Liberty St. SE / Room 320 / Salem, OR 97301-3513 503-588-6256 * baspac@cityofsalem.net If you need the following translated in Spanish, please call 503-588-6256.Si usted necesita lo siguiente traducido en español, por favor llame 503-588-6256.

Work site location and informationParent permit #

(required when site has other building permits)Street address of work site

Category of construction Commercial Multi-family One/Two family

Type of Work New Addition Alteration/Repair Backflow device only Residential fire system-13D Multi-purpose loop (requires plan review & separate permit);

Project Description

People informationSame as

Applicant? Name Full Mailing Address Phone Number and Email address

Applicant (person responsible for the permit)Property owner Yes

NoContact (person receiving correspondence)

YesNo

Contractor (person or company doing the work)

YesNo

Oregon Construction Contractors Board (CCB) Number: ____________________Plumbing Business License Number: ____________________ Journeyman License Number: ____________________Landscape (LCB) Number: ____________________

Project informationCommercial work requiring

plan review: check all that apply

Medical gas and vacuum system for healthcare facility Chemical drainage waste and vent system Sewer wastewater pre-treatment Vacuum drainage waste and vent system Commercial potable water pressure booster system Water service line with interior diameter of 2 inches or larger Grease trap/Interceptor Exterior storm sewers on private property (catch basin/area drain) None of the above

(For office use only)Permit #:

Plumbing Permit Application - 12/19/19IAS Code(s): 4.2.1.1.5.5.1.3

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Fees

Description Qty Each TotalNew 1 & 2 Family dwellings - Includes 1 kitchen and up to 100' each of water, sewer, and storm lines (rain, footing, trench drains, leach lines, drywells)Check the number of bathrooms(A "half" bath equals a single bathroom)

1 bathroom $285.002 bathrooms $363.003 bathrooms $441.00

Number of additional bathrooms or kitchen $78.00Residential Fire Suppression (13D Multi-purpose loop). Square feet of area to be covered by the system:0 to 2000 ($98.00)2,001 to 3,600 ($103.50)3,601 to 7,200 ($139.75)Over 7,200 ($186.25)Site Utilities (Commercial or residential)Catch basin or area drain $17.50Storm sewer (incl trench drains, leach lines) Linear feet

1st 100' of line $41.00Each additional 100’ or fraction $26.00

Sanitary sewer Linear feet1st 100' of line $41.00

Each additional 100’ or fraction $26.00Water service Linear feet

1st 100' of line $41.00Each additional 100’ or fraction $26.00

Footing drain Linear feet1st 100' of line $41.00

Each additional 100’ or fraction $26.00Rain drain Linear feet

1st 100' of line $41.00Each additional 100’ or fraction $26.00

Manufactured home utilities (beyond 30') Linear feet1st 100' of line $41.00

Each additional 100’ or fraction $26.00Medical Gas Installation-Commercial (Fees are based on the value of the work performed.)Valuation (The value, rounded up to the nearest thousand, of all equipment, materials, labor, overhead and the profit of the work indicated on this application.)

$0 to $2,000 $67.25

$2,001 to $25,000$67.25 for the first $2,000 $67.25plus $8.00 for each additional $1,000, or fraction thereof to and including $25,000 8.00

$25,001 to $50,000$251.25 for the first $25,000 $251.25Plus $6.25 for each additional $1,000 ,or fraction thereof, to and including $50,000 $6.25

$50,001 to $100,000$407.50 for the first $50,000 $407.50

Plus $4.75 for each additional $1,000, or fraction thereof, to and including $100,000 $4.75

$100,001 and up$645.00 for the first $100,000 $645.00Plus $3.95 for each additional $1,000, or fraction thereof. $3.95

Plumbing Permit Application - 12/19/19IAS Code(s): 4.2.1.1.5.5.1.3

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Fixture or Item (New multifamily/New commercial; Commercial & Residential Additions/Alterations/Repairs)Absorption valve 17.50Backflow preventer (water) 26.00Backwater valve (storm or sewer) 26.00Clothes washer $17.50Dishwasher $17.50Drinking fountain $17.50Ejectors/sump $17.50Expansion tank $17.50Floor drain/floor/ sink/hub $17.50Garbage disposal $17.50Hose bib $17.50Ice maker $17.50Interceptor/grease trap $17.50Primer $17.50Roof drain (commercial) $17.50Sink/basin/lavatory $17.50Tub/shower/shower pan $17.50Urinal $17.50Water closet $17.50Water heater (new or replacement) $17.50Other fixture (be specific, e.g., manhole) $17.50

Plumbing Permit FeeA) Permit Subtotal (from above checklist)B) Minimum Permit Fee (only applicable if line A is less than $67.25) $67.25C) Permit Total (A or B per above)D) Investigation Fee - Working without permits ($67.25 per hour not to exceed Line C)E) Plan Review (30% of Permit Total – Line C x 0.30) + automation fee ($2.50<$50; $5>=$50)F) State Surcharge (12% of Permit Total – Line C x 0.12)H) Permit automation fee - $5.00

TOTAL PERMIT FEE

NoticesExpiration of application: This application is valid for 180 days after it has been accepted as complete.Inspections required: Approved city inspections must be completed before the work performed is enclosed.

Terms and conditionsCorrect information: I hereby certify I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not.

Copyright release for government entities: I hereby grant permission to the City of Salem to copy, in whole or part, drawings and all other materials submitted by me, my agents, or representatives. This grant of permission extends to all copies needed for administration of the City’s regulatory, administrative, and legal functions, including sharing of information with other governmental entities.

Indemnity: I, the permit applicant, shall indemnify, defend and hold harmless the City of Salem, its officers, employees and agents from any and all claims arising out of or in connection with work done under this permit.

Owner installation: This installation is being made on residential or farm property owned by me or a member of my immediate family. This property is not intended for sale, exchange, lease, or rent.

Plumbing Permit Application - 12/19/19IAS Code(s): 4.2.1.1.5.5.1.3

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Owner permission: I have the legal right or permission from any property owner whose property is affected by the work covered under this permit to: 1) enter the property; 2) perform the work covered under this permit; 3) leave structures on or in the affected property. The issuance of this permit shall not be construed as permission or a grant of a legal right to enter upon or remain on any property affected by the work covered under this permit.

Electronic signature certification: By attaching an electronic signature (whether typed, graphical or free form) I certify herein that I have read, understood and confirm all the statements listed above and throughout the application form. I agree (initials): ______

Authorized Signature: ______________________________________________________________________ Print Name: _____________________________________________ Date: _________________________

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Plumbing Permit Application - 12/19/19IAS Code(s): 4.2.1.1.5.5.1.3

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