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FOR CITY USE ONLY <br />Received By: Date: <br />Zoning By: City: <br />Receipt ~: Amount: $. <br /> <br />PLUMBING PERMIT APPLICATION I <br />Please complete all Sections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK <br />IS NOT STAR~ED WITHIN 180 DAYS OF ISSUANCE OR IF <br />WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INFORMATION <br /> <br /> Plum~ ~: <br /> <br /> ~ B~ <br /> Regis~ation Nu~ <br /> <br />~. ~R OW~R ~ST~LA~ON <br /> <br />Prope~y Owne~. (please print) <br />Mailing Address: <br />City: State: Zip: <br /> <br />I am the PROPERTY OWNER and own, reside in, or will reside in <br />the completed structure and will be my own general contractor. I <br />understand that I must register as a construction contractor if the <br />structure is sold or offered for sale before or upon completior~ lf l <br />him subcontractors, I will hire only subcontractors registered with <br />the Construction Contractors Board. If I change my mind and do <br />hire a general contractor who is registered with the Construction <br />Contractors Board, I will immediately notify Marion Coumy of the <br />name of the contractor. <br /> <br /> Owner's Signature: <br /> <br /> Agent's Signaw, re: <br /> <br />3. PLAN REVIEW SECTION <br /> <br />Marion County doe~ not require a plan review. We will pwvide plan I <br />review service if you complete Section 5B and submit two (2) sets of <br />plans and specifications w th this app cation. <br /> <br />MC 15-45 Rev 9/98 <br /> <br /> MARION COUNTY BUILDING INSPECTION <br /> 3150 Lancaster Dr. NE - Suite C <br />Salem, O~gon 97305 <br />8:00am - 4:30pm 24 HR Inspection Line 373-4427 FAX 588-7948 <br /> <br /> 4. FEE SCItEDULE (cmnple~and enter total in S-Al below) <br /> <br />( ) RESIDENTIAL ( ~L'OMMERCIAL ( ) GAS ( ) ELECTRIC <br />( - ) NEW ( ~DITION ( ) ALTERATION ( ) R~LOCATION <br /> <br />Fixtures (New / Alteration) OTY. OTY. <br />Area Drain -- Interceptor <br /> <br />Bidet Show~ <br />Catch Basin '~ Sink <br />Clothes Washer -- Trough Drain -- <br />Dental Unit -- Tub/Shower <br />Cuspidor -- Urinal <br /> <br />Reconnect (pe~ fixture) -- x $7.50 = $__ <br />Lawn Vacuum Breaker -- x $730 = $__ 1 <br />Other Vacuum Break~ Devices -- x $10.00 -- $__ <br /> <br />Residential: First l00 fl., or fraction thercof -- x $35.00=$__2 <br /> For ea addn1100 fl, up to 500 fl x $16.00 = $__ <br />Commercial:Firstl00B. of fraction themof -- x $35.(]0=$__ <br /> Foreaaddnll00feex -- x $20.00=$__ <br /> <br />Residential: Fhat 100 fL, Of fr~tion thereof ~r. x $35.00 = $ ~.~ <br /> For ea addn110(} ft. up to 500 ft x $16.00--$__ <br />Conunevcial: First 100 fi., or fraction thereof -- x $35.~0 = $ -- <br /> Foreaaddnll00feet -- x $20.00=$__ <br /> <br />Minor Installation Label~ __ x $10.00 = $ -- <br />Pack of 10 labels @ $10.00 each, <br />sold only to Plumbing coatractors) <br /> <br />One/TwoFamllyDwell~Fe~SquamFecc -- x $ .09=$__ <br /> <br />BASE FEE Assessed on ALL APPLICATIONS: <br />(Exception: W~er/Sewer ~ Applications wino fixtures) <br /> <br /> Al. Enter total of fee~ from Semion #4 <br /> A2. Add Sta~ Surcharge (.05% x Al + Base Fee) <br /> <br />SUBTOTAL <br /> <br />B. En~r 30% of line A1 for Plan Review <br />C. Investigation Fee (if r~q~ired) <br />D. P.~inapection Fee ($50.00) <br /> <br />$ 25.0~ <br /> <br /> <br />