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LOCATION OF INSTALLATION <br /> <br />Parcel ID: s <br /> i~A~,: IIqO L~coM CT- <br /> <br />Cross SUeetiDirecfions: [ I-~'~ ~,T <br /> <br />Project Description: ~¢~60~C~0~ ~?r'ldk.~14 ~r <br /> <br />PERMITS ARE NON- TRANSFERABLE AND EXPIRE IF WORK <br />IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br />WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INFORMATION <br /> <br /> Conuactor: <br /> <br /> Mailing Address: <br /> <br /> City: State: Zip: <br /> Phone: <br /> <br /> Plumbers License: <br /> <br />Regiswation Number: <br /> <br />Con~tacmr's Signature: <br /> <br />2B. FOR OWNER INSTALLATION <br /> <br />Mailing Add~css: q'~O '~:R3~. [ 1'2-"] <br /> <br />c~,: ¢'%m,¥~lk. state: On- zip: <br /> <br />I am t~ PROPER~ 0~ ~ ~ ~sMe i~ or will ~side in <br /> <br />st~tu~ is soM or offend for sa~ befo~ or u~n co~leao~ lf I <br /> <br />Contr~Wrs Boa~ I will ~d~tely ~t~ Ma~n Coun~ of t~ <br /> <br />Owner's Si~a~:~ <br />Ag~t's Signa~: <br /> <br />3. PLAN REVIEW SECTION <br /> <br />Marion County does no~ require a plan review. We will provide plan <br />review service if you complete Section 5B and submit two (2) sexs of <br />pans and spec fications with this application. <br /> <br />MC 15-45 Rev 9/98 <br /> <br />RECEIVED <br /> <br /> MARION COUNTY BUILDING INSPECTION~ <br /> 3 150 Lancaster Dr. NE - Suite C ~,,- <br /> Salem, Oregon 97305 ~JOO L <br />8:00am - 4:30pm 24'/-IR Inspection Line 373-4427 ./{J' <br /> qq¢ 7 <br /> IJILDI.G <br /> 4. FEE S~EDULE (complete and enter t~d in S-A1 below) <br /> <br />(~iDENIIAL ( )COMMERCIAL <br />( ) hEW ( ) ADVmON <br /> <br />Fhttures (New / Alteration) <br />Area Drain <br />Backflow Prevention Device <br />Bathtub <br /> <br />Catch Basin <br />Clothes Washer <br />Dental Unit <br />Cuspidor <br /> <br />Recmmect {per fixture) <br /> <br />Minor Installation Labels <br />Pack of 10 labels @ $10.00 each, <br /> sold only to Plumbing contractma) <br /> <br />( )OAS ( )ELECTRIC <br />( ) ALTERATION ( ) RELOCATION <br /> <br /> OTY. OTY. <br /> ~ Laundry Tub <br /> <br /> Shower <br /> Sink <br /> -- Ttough Drain <br /> <br /> / x $15.00 = $ ,~,.(~'s' 4 <br /> ~ x $7.50=$ ~._~.n 1 <br /> <br />x $25.00 = $ 2 <br />x $16.00 = $ <br />x $30.00 = $ <br />x $20.00=$__ <br /> <br />$35.00=$__2 <br />$16.00=$__ <br />$35.00 = $ -- <br />$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 />BASE FEE Asses$*d on ALL APPLICATIONS: <br />(Exc~ption: Water/Sewer Line Applicafio~ wino fixtures) <br /> <br /> A1. Enter totai of fees from Section #4 <br /> A2. Add State Surcharge (,g5 ,% <br /> <br /> SUSTOTnC <br /> B. Enter 30% ofli~ A1 for Plan Rcvic,~//O~r' <br /> c, · . · · /.r;4 <br /> D. Reinspection Fee ($50.00) <br /> E. Additional Plan Review ($62.50/hr, <br /> minimum one-half ho*x) <br /> F. Inspection for which no f~ is specifically indicated, <br /> ($62.50/hr, minimum one hour) <br /> G. Inspection Outside Normal Busincs~ Hours, <br /> ($62.50/hr, minimum two horns) <br /> <br /> TOTAL AMOUNT <br /> <br /> <br />