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Received 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 /> tan-' a n,t . <br />Project Description: ~O$~CT- '?"O~/~ <br /> <br />PB~I~ ~ NON-~SF~B~ AND B~IR~ IF WO~ <br /> NOT ST~T~ W~HIN 180 DAYS OF ISSU~Cg OR IF <br />WO~ lS SU~END~ FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INFORMATION <br /> <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 tbe <br />structure is sold or offered for sale before or upon completion. If l <br />him subconozmtors, 1 will him only subcontractors registered with <br />the Construcn~n Contractors Board. If I change my mind and do <br />him a general contractor who is registered with the Construction <br />Contractors Boar~ I will immediately notify Marion County of the <br />name of the contractor <br /> <br />Owncr's Signature: <br />Agent's Signamre:ff~a-a~Lt~l l -'~'~--~t/ <br /> <br />3. PLAN REVIEW SECTION <br /> <br /> Marion County does not require a plan review, We will provide plan <br /> review service if you complete Section 5B and submit two (2) sets of <br /> plans and spccificzfions with this application. <br /> <br />MC 1545 Rev 9/98 <br /> <br /> 3150 Lancaster Dr. NE - Suite C <br /> Salem, Oregon 97305 <br />8:00am - 4:30pm 24 HR Inspection Line 373-4427 FAX 588-7948 <br /> <br />4. FEE SCHEDULE (complete and enter total in 5-Al below) <br /> <br />( ) NEW ( ) ADDITION <br /> <br />Recmm~ (l~r fixtu~) <br /> <br />Wa~r ~h~ <br /> <br />Minor Imtallaflon Labels <br />Pack of 10 labels @ $10.00 each, <br /> sold only to Plumbing contractors) <br /> <br />~Two gan~ly Dw~ng g~: Squw~ I~c -- <br /> <br />)GAS ( )ELECTRIC <br />) ALTERATION ( ) RF. LOCATION <br /> <br /> x $25.00 = $ 2 <br />x $16.00=$__ <br />x $30.00=$__ <br />-- x $20.00=$__ <br /> <br /> x $35.00=$__2 <br />x $16.00=$__ <br />/ x $3~.oo = $ <br />I x $2o.0o=$~O. <br /> <br /> x $35.00--$__2 <br />x $16.00=$__ <br />x $35.00=$__ <br />__ x $20.00=$__ <br /> <br />-- x $10.00=$__ <br /> <br />x $ ,09 -- $__ <br /> <br /> $__ <br /> <br />SUBTOTAL <br /> <br />B. Enter 30% of line Al for Plan R~vi~w <br />C. Investigation Fee (if require) <br />D. Reinspection Fee ($50.00) <br />E. Additional Plan R~view ($62.50Yhr, <br />rainimum one-half hour) $ -- <br />E Inspection for which no fee is specifically indicated, <br />($62.50/hr, minimum on~ hour) $ -- <br />G. Inspe~tion Outside Normal Business Hours, <br />($62.50/hr, minimum two hours) $ -- <br /> <br /> TOTAL/d~IOUN"F D~ $ _ _ <br /> <br />s <br /> <br />$__ <br />$__ <br /> <br /> <br />