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FOR CITY USE ONLY <br />Received By: Date: <br />Zoning By: City:. <br />Receipt #: Amount: $ <br /> <br /> I <br />PLUM~ING PERMIT APPLICATION ] <br /> Please complete all Sections, 1 through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />Pa.mol ID: <br /> <br />ci~: ~k.,~z~a.~ ret3 zip: <br /> <br />Phone: <br /> <br />Project Description: ~.2._~ {-J~ ~ <br /> <br />PERMITS ~IRE NON-TRANSFER.4BLE AND EXPIRE IF WORK] <br />IS NOT STARTED WITHIN18O DA YS OF ISSUANCE OR IF I <br />WORK lS SUSPENDED FOR lgO DAIS. I <br /> <br />Plumbers License: <br /> <br />Journeyman Plumbing License: <br /> <br />Conlractm's Board <br />Registration Number: <br /> <br /> Con~acteT'a Signature; <br /> <br />2B. FOR OWNER INSTALLATION <br /> <br /> Property Owner,. (please print) <br /> <br /> Mailing Address: <br /> <br /> Ci~: Slate: Zip: <br /> <br />I am the PROPERTY OWNER and I reside in, or will reside in the completed <br />st~¢ture and wtll be my own generaI contractor, l understand that l must <br />r~gister as a construction contractor if the struclure is sold or offered for sale <br />before or upon completion. If l hire subcontractors, I will hire only <br />subco~ntractors registe~d with the Construction Contractors Board. If[ <br />change my mind and do hire a general contractor who is registered with the <br />Construction Contractors Board, I will immediately notify Marion County of <br />the name of the contractor: <br /> <br />Owner's Signature: <br /> <br />Agent's Signature: <br /> <br />3. PLAN REVIEW SECTION <br /> <br />Marion County does not require a plan review. We w~ll provide plan review <br />s ~'ice if you complete Section 5B and submit two (2) sets o£plans and <br />spedfications 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, Oregnn 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 S-A1 below) <br /> <br />) NEW ( ) ADDITION <br />Cuspidor <br /> <br />Coramcrclal:First 10OfL or fracfionthe~eof [~){...] x <br /> <br />( ) GAS ( ) ELECTRIC <br />( ) ALTERATION ( ) RELOCATION <br /> <br /> OTY. OTY, <br /> -- Intcrcepwr <br /> -- Laundw Tub <br /> <br /> -- Trough Drain -- <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 />$35.0O= $__2 <br />$16.00= $ <br />$35.00= $ <br />$20.00= $__ <br /> <br />$35.00= $__2 <br />$16.00= $__ <br />$35.0O= $__ <br />$20.00= $__ <br /> <br />Minor Installation Labels -- x $10.0O = $ __ <br />Pack of 10 labels @ $10.0O each, <br />sold only to Plumbing contractors) <br /> <br />$. FEES <br /> <br />BASE FEE Assgsstd on ALL APPLICATIONS: <br />(Exception: Wat~/Sewer Linc Applications w/no fixtores) <br /> <br /> Al. Enter tom[ of fees from Section #4 <br /> A2. Add State Surcharg~ (.05% x A1 + Base Fee) <br /> <br />SUBTOTAL <br /> <br />$ 25.00 <br /> <br />$ <br /> <br />$ <br /> <br />$ <br />$__ <br />$ <br /> <br />B. Enter 30% of line A1 for Plmx Re'dew <br />C. Investigation Fee (if required) <br />D. Ralnspection Fee ($60.00) <br />E. Additional Plan Review ($62.50/hr, <br /> minimum one-half hour) <br />E Inspection fer which no fee is specifically indicated, <br /> ($62.50/hr, minimum one hour) <br /> <br /> ($62'50/hr' minimum tw° h°~rS)ToTAL AMOUNT DUE <br /> <br /> <br />