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FOR CITY US~ ONLY <br />Received By:. Da~: <br />Zoning By: City: <br />Receipt #: Amount: $ <br /> <br />PLUMBING PERMIT APPLICATION <br /> Please complete all Se6~ions, 1 through 5 <br /> <br />2B. ~OR O~bIER <br /> <br />City: S~ale: Zip: <br /> <br />lam tI~ PROPER~Y OP/NER ond I reside i~ or wlll reside in the completed <br />s~cOtre cmd wilt be my own ggneral ¢ontractor. I understond that I mugt <br />reg~ter as a construction contractor if tile so'uct~r~ is sold or offered for <br />befo~ or upon complefior~ if l hire ~thcontractors, 1 will ~ only <br />st~bcontt~to~ registered with the ConMruction Contractors Boar& <br />change my mind a~d d~ hire a general contr~tor who is re~4stered with the <br />Conaa~ucflon Contnactors Boar~ I will irame~ate~ notify Marion Counly of <br />the name of the contractor: <br /> <br /> Owner's Signature: <br /> <br /> Agent's Signatme: <br /> <br />3. PLAN REVIEW SECTION <br /> <br /> Matin~ ~unt~ d~s u~t ~quir~ a p~ t~vie~. We willprovide ptan review <br /> ~i~ ~you co~k~ ~o~ 5B ~d su~ ~o (2) ~ ofp~ ~d <br /> epe~ w~ ~ ~pff~on. <br /> <br /> MARION COUNTY BUILDING INSPECTION <br /> 3 150 Lancaster Dr. NE - Suite C <br /> Salem, Oregon 97305 <br />8:00 am - 4:30 pm 24 hr. Inspection Line 373-4427 <br /> <br />FAX 588-7948 <br /> <br />4. FEE SCHEDULE (Complete and enter totalin .~A1 I~low) <br /> <br />;) <br /> <br />SIDENTIAL ( )COMMERCIAL ( )GAS ( )ELECTRIC <br /> <br />( ) NEW ( ) ADDITION ~I~ALTERAT1ON ( ) <br /> KELOCAT!ON <br /> <br />Firtures (New / Alteration) OF.. QTY. <br />Ama Drain Interceptor <br />Ba~o~ Prevention Device -- LaundryTub <br />~ -- Receptor <br />Bidet Shower <br />C4d~h Basin 'Sink <br />Ctolhas Waflxer ~ Trough Drain <br />Demal Unit -~ Tub/Shower <br />Cuspidor ~ Urinal <br />Dirking Fountain Water Closet <br /> <br />R~-onn~'t(l~rfimur~) x $7.50 = $__ <br /> <br />Re. sidenfial:Fkstl0Ofl.,orfractionthergof -- x $35.00 --$ <br /> Foreaaddnll00fl, up to S00 feet -- x $16.00 = $ <br />Commcrcisl:FirstlO0fl.,orfractinnfl~of -- x $35.00 =$__ <br /> For ca add~1100 feet x $20.00 = $ <br /> <br />, Minor ~ Lal~ls <br />] pack of 10 labels ~ $10.00 each, <br /> sold only to Plumbing con'lracto~s) <br /> <br />l)weffing Permit ]-abels <br />(For New Single Family Dwellings Only) <br /> <br /># of Lal~ls <br /> <br />One/TwoFalm~yDwe~ing Fee 8quareFeet: x $ .09 = $ <br /> <br />A3. Add Sta~e Surcharge (.05% x A1 + A2) <br /> <br />B.' Enter 30% of llne A1 for Plan Review <br />C. Investigation Fee, ifr~luired <br />D. Reinspeciion Fee ($50.00) <br /> <br />I O~her (~ required by Ibc Building Official) $ <br /> <br />5. FEES <br />A 1. BA~E FEE A~ea,ted o~ ALL APPLICATION~: $ 2~.00 <br />(~xcepfion: Water/So. wr Line Applications w/no filtrates <br />A2. Emer total F~ from Segtinn g4 <br /> SUBTOTAL: $ <br /> <br />K A~difional Plan Rex, i~ ($62.50/hou~, mi~anum o~e halfhou0 <br />F. Inspe~ion for which no fee is epe¢ifically indicated <br /> minimum on~ hour) <br />G. Inspection Oulzide Normal Business Hours ($62.50/hr, <br /> minimum two hour~) $ -- <br /> TOTAL AMOUNT DUE <br /> <br /> <br />