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.FOR CITY USE ONLY Received By: Date: Zoning By:. City: R~ceipt #: Amount: PLUMBING PERMIT APPLICATION Please complete all Sections, 1 through 1. LOCATION OF InSTAlLATION Parcel ID: City: Zip: Parcel Owner: Phone: Cross Street/Directions: Project Description: PERMITS ARE NON-TP~4NSFEP~4BLE AND EXPIRE IF lS NOT STAR TED WITHIN 1 $0 D/I Y$ OF ISSUANCE OR IF WORK IS SUSPENDED FOR 180 DAYS~ 2A. CONTRACTOR INFORMATION Contractor: Mailing Address City: State: Zip: Phone: Fax: Plumbers License: Journeyman Plumbing License: Contractors Board Registration Number: Contractor's Signature: 2B. FOR OWNER INSTALLATION I am the PROPERTYOPfNER and I reside in, or wiB reside in the completed structure and wilt be my own general contractor. I understand that I must register as a construction contractor if tbe structure is sold or offered for sale before or upon completion. If l hire subcontractors, I will hire only subcontractors registeredwith the Construction Contractors Board. Ill change my mind and do hire a general contractor who is registered with the Construction Contractors Board. I will immediately notify Marion County of the name of tbe contractor: Agent's Sign~:. --~[.k.~Lc ~ kK~ffJ.~t~t.J.A~ .~ 3. PLAN REVIEq~ SECTION ~ Marion County does not require a plan review. We .w_ !11 pro,de. service if you complete Section 5B and submit two (2) sets of plans and specifications with this application. 15-45 REV 3/99 MARION COUNTY BUILDING INSPECTION 3150 Lancaster Dr. NE - Suite C Salem, Oregon 97305 8:00am - 4:30pm 24 HR Inspection Line 373-4427 FAX 588-7948 4. FEE SCItEDULE (complete and enter total in 5-Al below) ( ) RESIDENTIAL ( ) COMMERCIAL ( ) GAS ( ) ELECTRIC ( ) NEW ( ) ADDITION ( ) ALTERATION ( ) RELOCATION F/xtures (New / Alteration) OTY. OTY. Area Drain -- Interceptor Backflow Prevention Device -- Laundry Tub Bathtub -- Receptor Bidet Shower Catch ftasin Sink Clothes Washer -- Trough Drain -- Dental Unit -- Tub/Shower Cuspidor -- Urinal Drinking Fountain -- Water Closet -- Floor Drain -- Water Heater Wet Bar Other Tot~lgFixtures -- x $15.00=$ 4 Reconnect (per fixRure) -- x $7.50 = $ Lawn Vacuum Breaker -- x $7,50 = $ 1 Other Vacuum Breaker Devices -- x $10.00 = $ B. Enter 30% of line A 1 for Plan Review C. Investigation Fee ([f required) D. Reinspection Fee ($50.00) ~ E. Additional Pica Review ($62.50/hr, mini =one-half o ) .~ ~F. Inspection for which no fee is indicated, ($62.50/hr, minhmun one hour) G. Inspection Outside Normal Business Hours, ($62.50/hr, ndnimum two hours) TOTAL AMOUNT DUE SUBTOTAL 5. FEES BASE FEE Assessed on ALL APPLICATIONS: (Exception: Water/Sewer lane Applications w/no fixtures) Al. Enter total of fees from Section g4 A2. Add State Surcharge (.05% x A1 + Base Fee) Residential: First 100 ft., or fraction thereof -- x $25.00 = $ 2 Foreaaddnl 100ft, uptoS00fl x $16.00=$__ Commercial: First 100 ff., or fraction thereof -- x $30.00 = $ Foreaaddnll00feet -- x $20.00=$ Residential: Fkstl00ft.,orfractlonthereof __ x $35.00=$__2 For ca addn1100 ft, up to 500 ft x $16.00=$__ Comn~ercial:Fh'stl00fi.,orfraedonthetcof __ x $35.00=$__ For ca eddnl 100 feet x $20.00 = $__ Storm Drains/Rain Drains Residential: First 100 ft., or fraction thereof -- x $35.00 -- $ 2 For ea addn1100 fl, up to 500 ft x $16.00 = $__ Commereial: First l00 ft., or fraction theaeof -- x $35.00=$__