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-gOR CITY USE ONLY <br />Received By: Date: <br />Zoning By: City:. <br />Receipt #: Amount: <br /> <br />1. LOCATION OF INSTALLATION <br /> <br /> Parcel ID: <br /> <br /> Cross S~e~imcfi~s: <br /> <br />PERMITS ARE NON-TP~4NSFER.4BLE AND EXPIRE IF WORE] <br />IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br />WORE IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INFORMATION <br />Contractor: <br /> <br /> Mailing Address <br /> <br /> City: State: <br /> Phone: <br /> Fax: <br /> Plumbers License: <br /> $oumelanan Plumbing License: <br /> <br />2B. FOR OWNER INSTALLATION <br /> <br />Property Owner: (please prinO <br /> <br />Mailing Address: <br /> <br /> stat~: 0 ¥ <br /> I am the PROPERTY OWNER and 1 reside in, <br /> structure and will be my own general contractor. I understand that I must <br /> register ~ a construction contractor if the structure is sold or offet~l for sale <br /> before or upon completion, lf l hire subcontractors. I will hire only <br /> subcontractors registered with the Construction Contractors Board. If l <br /> change my mind and do hire a general contractor who is registered with the <br /> Construction Contractors Board. I wilt immediately notify Marion County of <br /> <br />I Agent's - '~ ~/' ' <br /> Signature: <br /> <br />3. PLAN REVIEW SECTION <br /> <br />Marion County does not require a plan review. Wc will provide plan review <br />service if you completo Section 513 and submit two (2) sets of plans and <br />spec fications 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 />4. FEE SCHEDULE (complete and enter total in 5.A1 below) <br /> <br />( )RESIDENTIAL ( )COMMERCIAL <br /> <br />( )NEW ( )ADDrrlON <br /> <br />( ) GAS ( ) ELECTRIC <br /> <br />( ) ALTERATION ( ) RELOCATION <br /> <br /> OTY. OTY. <br /> Interceptor <br /> -- Laundry Tub -- <br /> -- Receptor <br /> Shower <br /> -- Sink <br /> <br /> -- Trough Drain -- <br /> <br /> -- Tub/Shower <br /> <br /> -- Urinal <br /> <br /> __ Wate~ Closet <br /> Water Heater <br /> <br /> ~t x $7.50 = $ <br /> <br />__ x $25.0O=$__2 <br />x $16.00 =$__ <br />x $30.00=$__ <br />x $20.00=$__ <br /> <br />x $35.00=$__2 <br />x $16.00=$__ <br />x $35.0O = $ <br />x $20.00=$__ <br /> <br /> x $35.00 = $__2 <br />x $16.00=$__ <br />x $35.00 = $ <br />__ x $20.00=$__ <br /> <br />Minor Installation Labels -- x $10.00 = $ -- <br />Pack of 10 labels @ $10.0O each, <br />sold only to Plumbing contractors) <br /> <br />Dwelling Permit Labels ~of Labels __@ $ N/C <br />(For New Single Family Dwellings Only) <br /> <br />OnefPwoFam~yDwegtogF~:SquamFect: __ x $ .09=$__ <br />Othex (as required by the Building Official) $ -- <br /> <br />g. FEES <br /> <br />BASE FEE Assessed on ALL APPLICATIONS: <br />(Exception: Water/Sewer Line Applications w/no fixtures) <br /> <br /> Al. Enter total of fee~ from Section g4 <br /> <br /> A2. Add State Surcharge (.05% x A1 + Base Fee) <br /> <br />B. Enter 30% of line A1 for Plan Review <br />C. Investigation Fee (if required) <br />D. Rdinspection Fee ($50.00) <br />E. Additional Plan Review ($62.50dtr, <br /> minimum one-half hour) <br />E Inspection for which no fee is specifically indicated. <br /> ($62.50/hr, minimum one hoar) <br />G. Inspection Outside Normal Business Hours, <br /> ($62.50fnr, minimum two hours) <br /> <br /> TOTAL AMOUNT DUE <br /> <br />$ 25.00 <br /> <br />$__ <br />$ <br /> <br /> <br />