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FOR CITY USE ONLY <br />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 /> <br /> rip: <br /> <br />City:~ ~ <~ k) ~-L~ <br />Parcel Owner: <br /> <br />CmssStxeet/Directions: ~W~ ~ ~Z~L <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK <br />lS NOT STARTED WITHIN 180 DAYS OF ISSUANCE OR IF I <br />WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />Mailing Address: <br />Ciiy: State: Zip: <br /> <br />Plumbers License: <br /> <br />2B. FOR OWNER INSTALLATION <br /> Property Owner. (please print) ~,~ [:~tt.~'-~ ~ , j~(&~, v~ tx,) <br /> <br />I am the PROP~ OWNER ~d ow& ~side in, or will msi~ ~ <br />st~mm is soM or offemd for sale ~o~ or ~n co~letio~ lfl <br /> <br />Cont~tors B~ I will i~d~tely no~ Ma~on Cou~ of t& <br /> <br />3. PLAN REVIEW SECTION <br /> <br />Marion County does not require a plan review. We will provide plan I <br />review service if you complete Section 5B and submit two (2) sets of <br />plans and specifications with this app cation. <br /> <br />MC 1545 R~v 9/98 <br /> <br /> MARION COUN'FY BUILDING INSPECTION <br /> 3150 Lancaster Dr. NE - Suite C <br />Salem, Oregon 97305 <br />8:00am - 4:30pm 24 HR Inspection Line 3734427 FAX 588-7948 <br /> <br />4. FEE SCHEDULE (complete and enter l~tal in 5-Al below) <br /> <br />~) ( ) COM/~RCIAL <br /> RESIDENTIAL <br /> <br /> ( ) NEW ( ) ADDITION <br /> <br /> Fixtares (New / Alteration) <br /> Area Drain <br /> Baekflow Prevention Device <br /> Bathtub <br /> Bidet <br /> Catch Basin <br /> Clothes Washer <br /> Dental Unit <br /> Cuspidor <br /> DrinMng Fountain <br /> Floor Drain <br /> Wet Bar <br /> <br /> Total # Fixtures <br /> Reconnect (p~r fixture) <br /> Lawn Vacuum Breaker <br /> Other Vacuum Bmak~ Devices <br /> <br /> Residential: First 100 ft, or L~action thereof -- <br /> For ~ a~dd1100 tL up to 500 ft <br />Comngrcial: First 100 R., or fraction thegof -- <br /> For ea addnl 100 feet <br /> <br />Residential: First 100R,,or fraetiontheteof -- <br /> F~ ~ adcinl 100 R, up te 500 ft <br />Commea-cial: Fimt 100 ft., c~ fraction thereof <br /> For ca edflnl 100 f~t <br /> <br />Resid~ntiah First 100R. orffacfionthegof -- <br /> <br /> For ea addn1100 ft, up to 5~0 fl -- <br />Commel~al: First 100 R., or fraction thee. of <br /> For ea addnl 100 feet <br /> <br />One/T~ Enmily l~ F~: Square F~t: -- <br /> <br />( ) (]AS ( ) ELECTRIC <br /> <br />( ) ALTERATION ( ) RELOCATION <br /> <br /> OTY. OTY. <br /> <br /> __ Sink <br /> -- Trough Drain -- <br /> <br /> -- Urinal <br /> <br /> $15.00 = <br /> $7.50 -- $'. <br /> <br /> __ x $10.00=$__ <br /> <br />x $25.00=$__2 <br />x $16.00=$__ <br />x $30.00 -- $__ <br />-- x $20.00--$__ <br /> <br />x $35.~0 = $__2 <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 $20.00=$__ <br /> <br />-- x $10.00=$ <br /> <br />x $ .09=$__ <br /> <br /> $__ <br /> <br />BASE FEE Assessed on ALL APPLICATIONS: $ 25.00 <br />(Exception: Water/Sewer Line Applications w/no fixtures) <br /> <br /> Al. Enter total of fees from Section #4 $ <br /> A2. Add Stat~ Surcharge (~fl~' x A1 + Base Fee) $ <br /> <br /> SUBTOTAL $ -- <br /> <br /> B. Enter 30% of line Al for Plan Review $ -- <br /> C. Investigation Fee 0f required) $ -- <br /> D. Reinspection Fee ($50.00) $ -- <br /> E. Additional Plan Review ($62.50/hr, <br /> minimum one-half ho~) $ -- <br /> E Inspection for which no fee is specifically indicated, <br /> ($62.50thr, minimum one hour) $ <br /> G. Inspection Outside Normal Business Hours, <br /> ($62.50/hr, minimum two hours) $ -- <br /> <br /> TOTAL AMOUNT DUE <br /> <br /> <br />