Laserfiche WebLink
FOR CITY USE ONLY <br />Received By: Date: <br />Zoning'By:~ ' ' City:. <br />Receipt #: Amount: $ <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />Parcct ID: <br /> <br /> Cftc zip: <br /> <br />Phone: 76~ -- 7O I0 <br />Cross <br /> <br /> PERMITS ARE NON~TRANSFER.4BLE AND EXPIRE IF WORK <br /> IS NOT STARTED WITHIN 180 DdYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAY$ <br /> <br />2A. CONTRACTOR INFORMATION <br /> <br /> City: State: Zip: <br /> Phone: <br /> <br /> Registration Number: <br /> <br />FOR OWNER INSTALLATION <br /> <br /> Agent's Signature: <br /> <br />3. PLAN REVIEW SECTION <br /> <br /> Marion County docs not require a plan re,dew. We <br /> service if you complete Section SB and submit two, <br /> specifications with this application. <br /> <br /> MC 15-45 REV 3/99 <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 /> 99 -07¢¢0 <br /> 4. FEE SCHEDULE (complete and enter total in S-A1 below) <br /> <br />( ) RESIDENTIAL ( ) COMMERCIAL <br />( )NEW ( )ADD1TION <br /> <br />Fixtures (New / Alteration) <br /> <br /> g0 <br /> <br />( ) GAS ( ) ELECTRIC <br />( ) ALTERATION ( ) RELOCATION <br /> <br />$25.00 = $ -- 2 <br />$16.0O = $__ <br />$30.00 = $ -- <br />$20.00 = $ -- <br /> <br />__ x $35.00=$ 2 <br />x $16.00 = $ <br />x $35.00=$__ <br />x $20,00=$__ <br /> <br /> x $35.0O=$__2 <br />x $16.0O = $__ <br />x $35.0O=$__ <br />-- x $20.0O=$__ <br /> <br />Minor Installation Labels -- x $10.00 = $ -- <br />Pack of 10 labels @ $10.00 each, <br />sold only to Plumbing contractors) <br /> <br />Dwelling PermR Labels #of Labels <br />(For New Single Family Dwellings Only) <br /> <br />One/T~FanffiyDw~lllnffFee:SquareFeet: __. x $ .09=$ <br />Other (as required by the Building Official) $ -- <br /> <br />5. FEES <br /> <br />BASE FEE Assessed on ALL APPLICATIONS: <br />(Exception: Water/Sewer Line Applications w/no fixtures) <br /> <br /> Al. Enter total of fccs from Section ~4 <br /> A2. Add State Surcharge (,05% x Al + Base Fee) <br /> <br /> NOTICE <br /> EFFECTIVE 7-1-99 <br />STATE SURCHARGE CHANGE <br />FROM 5% TO 7% <br /> <br />SUBTOTAL <br /> <br />B. Enter 30% of line Al for Plan Review <br />C. Investigation Fee (if required) <br />D. Reinsp~ction Fee ($50.00) <br />E. Additional Plan Review ($62.50/hr, <br />minimum one-half hour) <br />1: T~*~;.. ~r which no fee is specifically indicated, <br /> ~nimum one hour) <br /> atalde Norraal Business Hours, <br /> niuimum two hours) $ -- <br /> <br /> TOTAL AMOUNT DUE {Si__ <br /> <br /> 25.00 <br /> <br />$__ <br />$__ <br />$__ <br /> <br /> <br />