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FOR CITY USE ONLY <br />Received By: _Date: <br />Z~ning 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 /> <br /> Parcel ID: <br /> <br />Zip: <br /> <br />CmssSU~egDirections: .,F~" /o.o~fi~'~. ~7~ <br /> <br />PERMITS ARE NON. TRANSFERABLE AND EXPIRE IF WORK [ <br />Mailing Address: <br /> <br /> R~gis~zlion Number: <br /> <br /> Contraclor's Signature: <br /> <br />2B. FOR OWNER INSTALLATION <br /> <br />Propen~y Owner: (please print) <br />Mailing n~klress.~/~'~ ~7 <br /> <br />State: t~ 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 completiott If I <br />hire subcontractors, I will hire only subcontractors ~ <br /> <br />name of the c <br /> <br />Marion County docs not require a plan levi~w. We will provide plan I <br />review service if you complete Secllon 5B and submit two (2) s~s of <br />plans and specifications w th this appl cation. <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 24 HR Inspection Line 373-4427 FAX 588-7948 <br /> <br /> 4. FEE SCHEDULE (c~mple~ and enter ~ in S-A1 below) <br /> <br />( ) RESIDENTIAL ( ) COM/~RCIAL ( ) GAS <br /> <br />( ) NEW ( ) ADDITION <br /> <br />Fixtur~ (New I Al~:ration) <br /> <br />Cuspidor <br />Drinking Fountain <br /> <br />( )ELECTRIC <br /> <br />( ) ALTERATION ( ) P. ELC~ATION <br /> OYY. OTY. <br /> <br /> -- Receptor <br /> <br /> Trough Drain -- <br /> <br /> -- x $15.00--$ 4 <br /> -- x $7.50 = $ -- <br /> <br /> __ x $10.00=$__ <br /> <br /> _ x $25.00 = $ <br /> x $16.00=$__ <br /> x $30.00=$__ <br />-- x $20.00=$__ <br /> <br />_ x $35.00=$__ <br /> x $i6.00 = $__ <br /> x $35.00=$__ <br />. x $20.00=$__ <br /> <br />x $35.00=$__ <br />x $16.00=$__ <br />x $35.00 = $__ <br />x $20.00 = $__ <br /> <br />x $10.00 = $__ <br /> <br />~f Labels ~ $ <br /> <br /> x $ ,09 = $__ <br /> $__ <br /> <br />BASE FEE A~sessed on ALL APPLICATIONS: <br />(Exception: Wat~/Sew~r Lin~ Applicatioos w/no fixtures) <br /> <br /> Al. Ea~r total of fees from Section ~4 <br /> A2. Add Stata Surcharge (.05% x A1 + Bas~ Fee) <br /> <br />B. Enter 30% of line A I f~' Plan R~view <br />C. Investigation Fee (if r~luired) <br />D. R¢inspcction Fee ($50.00) <br />E. Additional Plan R~view ($62.50/hr, <br /> minimum one-half hour) <br />F. inspectio~ for which no fee is specifically indicated, <br /> ($62.50thr, minimmn one hour) <br />G. Inspection Outside Normal Business Hours, <br /> ($62.50/lu', minimum two hours) <br /> <br /> TOTAL AMOUNT DUE <br /> <br />2 <br /> <br />.2 <br /> <br />$ <br /> <br /> <br />