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MARION COUNTY BUILDING INSPBCTION <br /> <br />b~~U D~e: <br />~ ~su~ by: <br /> <br />COMMUNITY DEVELOPMENT CENTER <br />285 Church St NE · Room 132 <br /> Salem, OR 97301 <br /> <br /> 24 hr. Inspection Line 373-4427 <br />Office: Phone 588-5147 8:00am - 4:30pm <br />FAX: ~88-T94S <br /> <br />~TION <br />L Plea~e complete all Sections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br /> Phone - 5'~-7 <br />Mailin~ndd~as ~2~ ~'~ c~ ~ ~ <br /> <br />C~m,~,~o~No. ~7677 ] ~No. <br /> <br />Mai{in~ Addreaa [ Phono <br /> <br />City/State/Zip <br /> <br />Owner's Siguature: <br /> <br />Agent'a Signaling: <br /> <br />3. PLANRBVIBW SBCTION <br /> <br />Marion County does not require a plan review. <br />We will provide plan review service if you complete <br />Section 5B and submit two (2) sets of plans and <br />specifications with this application. <br /> <br />MC 15-45 <br />Rev. 1/96 <br /> <br />4. FBB SCHBDUI,B (Compl~ and ~te~ total in Al bdow) <br /> RBSIDBNTIAL ~ COMMERCIAL n <br /> USB O~rFRUCTURB: <br /> NEW ~ ALTERATION ra ADDITION 0 RELOCATION <br /> <br />Water I-inea <br /> l~st 100 ft. or fraction thercof <br /> For ea. addnr 100 fl. (up to <br /> mm of 500 ft.) <br /> <br />Sanita~ & Sloon Lines <br /> First 100 ft. or fraction thereof <br /> <br /> n~ximura of 500 ft.) <br />COblldBRCIAL (each <br /> <br /> R~xmuect <br /> <br />$20.00 <br />$15.00 <br /> <br />First 100 ft, or fraction thereof <br />For ea. addal' 100t~ <br /> <br />5. FBES Al. Enter Iotal of fea~ f~m Sec. {14 <br /> A2. Add 5% surcha~ (.05 x Al) <br /> <br />8ubt~al <br /> <br />B. Enter 25% of line A 1 for Plan Review <br /> (Al + .25), if required <br />C. Invesllgation Fee (if required) <br />D. Reimpe~lioa F~ ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br />Receipt No. <br /> <br />$15.00 <br /> <br />$10.00 <br />$10.00 <br />$10.00 <br /> <br />$15.00 <br /> <br />$15.00 -- <br /> <br />$4.50 <br />$10.00 -- <br /> <br />NIC <br /> <br /> <br />