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MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DE' tELOPMENT C~N~R <br /> 285 Church S: NE· Rpom 132 <br /> Salem OR 97301 - <br /> vote: <br /> <br /> ~ Hr In~ ton L~ 58&7~ i~AR[0N COUNTY <br /> O~: 588-5145 8:~a.m.-4:3Op.m. las~ by: <br /> F~, ~88-7948 5'UILDING INSPEC'i'tON <br /> <br />1. LOCATION OF I~STALLATION <br /> <br />PLUMBING PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />City y-~ ~-~ Cross St. <br /> <br />PERMITS APE NON-TRANSFeRABLE AND EXPIRg IF WORK IS NOT <br />STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS S~3SP£NDED FOR 180 DAYS, <br /> <br />2A. CONTRACTOR INSTALLATION oNLY <br /> <br />Con~t_,'aeto~ .................................... <br /> <br />Phone <br /> <br />Plumbing Boned: <br /> <br />2.B. FOR OWNER IlqgTALLATION$ <br /> <br />Property Owner, <br /> <br />City/State/Zip <br /> <br />Agcnt'~ Signatu~: <br /> <br />3. PLAN KEVIEW 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 />MC 1.5~.~ <br />Rev. 12/94 <br /> <br />4. F~ll SCHEDULB (Complete and enter total in Al below) <br /> <br /> RESIDBNTIAL [] COMIVIBRCIAL [] <br /> USIi OF STRUCTURB: <br /> NEW rn ALTERATION rn ADDITION CI RELOCATION <br /> <br /> bio. X F~o = Sum <br />BASE FElt, $20.OO <br /> <br />RESIDENTIAL (cash fixture) <br /> A ~ra Dwelling Plt.mbi~ Fee <br /> <br />Single Family or multi-fmnily pec <br />dwelling unit <br />New mnatmction <br />Alterafiom $10,00 , , <br /> <br /> Reloe~te(l Structure $ 5.00 <br /> ~dulat Sln~tu~ $ 5,00 <br /> <br />Water ]Lines <br /> First 100 ft. or fraction d~ereof <br /> Foe ca, addnl' <br /> maximum of 500 fi,) <br /> <br /> First IOO f~. or fraction <br /> For addnl' 100 ft. (~p to <br /> maximum of 500 P..) <br /> <br />$20.00 <br /> <br />$15.00 <br /> <br />$30.00 <br />SD.tX) <br /> <br />$10,00 __ <br />$10,00 ..... <br />$10.00 <br /> <br /> First 100 ft. or fraction Ihere~>f $25,00 ..... <br /> For ea. adflnl' 100 fl. (up to <br /> maxi~numof5oo fl,) $15.00 __ <br /> <br />Sanitary & Storm Lin~a <br /> <br /> and Buil&~g Ol~ciaD <br /> <br />5. FliES <br /> <br /> sumhar~ (~05 x Al) <br /> A2, <br /> 5% <br /> Subtotal $ <br /> <br /> (A I * ,25), if required $_~ <br /> C, Investigation Fca (ff~qui~d) <br /> D. R~imp~ctiO~l Fee ($25,~) $ <br /> <br /> TOT~ ~O~ DUB $ <br /> Receipt No. <br /> <br /> <br />