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FO~gCITY USE ONLY <br />Recdved By: Date: <br />Zoning By: .City: <br />Receipt #: ____Amount: $. <br /> <br />PLUMBING PERMIT APPLICATION <br />Please complete all Sections, 1 through 5 <br /> <br />1. LOCATION OF INSTALLATION <br />Parcel ID: <br /> <br />Cross Street/Directions: <br /> <br /> Project Description: <br /> <br /> ARE NON. TRANSFERABLE AND EXPIRE IF WORK <br /> PERMITS <br />IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> wo~r ts svsPEtgoED for ~so OARS. J <br /> <br />2A. CONTRACTOR INFORMATION <br /> <br /> Mailing Address: <br /> City: State: Zip: <br /> <br /> Plumbers License: <br /> <br /> Contractor's Signature: <br /> <br />st~tu~ ~ soM or ~md~r ~ ~o~ or ~n co~let~ lf l <br />~ s~on~actors, I will hi~ ~ly s~on~tors mgis~md with <br />t~ Co~ction Com~tors B~ lf l c~ge ~ ~ ~ do <br /> <br />Contr~tors B~ I wiH i~tely ~ ~ ~ of t~ <br />~ of t~ con tr~wr <br /> <br />3. PLAN REVIEW SECTION <br /> <br /> Marion County does not require a plan review. We will provide plan <br /> review service ff you complete Section 5B and submit two (2) sets of <br /> plans and specifications with this application. <br /> <br />MC 15-45 Rev 9/98 <br /> <br /> MARION COUNTY BUILDING INSPECTION <br /> 3150 Lancaster Dr. NE - Suite C <br /> Salem, Oregon 97305 <br />8:00am - 4:30pm ~ HR Inspection Line 373-~427 FAX 588-7948 <br /> q'$- /053¢ <br /> 4. FEE SCHEDULE (compTete and erder ~otal in 5-Al below) <br /> <br />( ) RESIDENTIAL ( ) COMMERCIAL <br /> <br />( ) NEW ( ) ADDITION <br /> <br />Flxtm~s (New / Alteration) <br />Azea Drain <br />Backflow Prevention Device <br />Bathtub <br />Bidet <br />Catch Basin <br />Clothes Washer <br /> <br />( ) GAS ( ) ELFL"rRIC <br />( ) ALTERATION ( ) RELOCATION <br /> <br /> OTY. OTY. <br /> <br /> __ Interceptor <br /> /...,.Laundry Tub -- <br /> -- Receptor <br /> <br /> -- Trough Drain __ <br /> Tub/Shower <br /> <br /> -- WatcrCloset -- <br /> ~.~Watex Heater -- <br /> <br /> __ x $7.50 = $ -- <br /> -- x $7.50=$__1 <br /> -- x $10.00=$__ <br /> / x $~.oo=$~' 2 <br /> x $16,00=$__ <br /> x $30.00=$__ <br /> x $20,00 = $ <br /> <br /> / x $3s.o0=$ <br /> x $16.00=$__ <br /> x $35.00 = $ <br /> __ x $20.00=$__ <br /> <br />x $35.00 -- $ 2 <br />x $16.00=$__ <br />x $35,00=$__ <br />__ x $20.~0=$__ <br /> <br />OnatrwoFamllyDwdflngFe~:Squa-cFecc -- x $ .09=$__ <br /> <br />C. Investigation Fee (if required) $ <br />D. Reinspecfion F~e ($50.00) $ <br /> <br />minimum one-half hour) ~.~ <br />F. Inspection for which no f~ is specifically indicated, <br />($62,50/hr, minimtun one hour) <br />G. Inspection Oulside Normal Busin~ Houm. <br />($62.50/hr, minimum two hours) $ __ <br /> <br /> $ <br /> <br /> <br />