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I~R~ ~USE ONLY <br />l~i¢~t By: Oate: <br />Zo0ing By: Ci~:. <br />Receipt ~: ~o~t: $ <br /> <br />IPLYING PERMIT APPLICATION <br /> Please complete allSec~ions, 1 through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> Parcel ID: <br /> <br />parcel Owncn <br /> <br /> Cross Street/Directions: <br /> <br /> Project l~ripfion: <br /> <br /> IS NOT gTARTED WITHIN 1~0 DA I~ OF ISSUANCE OR IF <br /> WORK IS SUSpENDED FOR 180 DA tX <br /> <br />2A. CONTRACTOR INFORMATION <br /> <br /> Contractor: <br /> <br /> Mailing Address <br /> <br /> City: State: Zip: <br /> <br /> Plumbers License: <br /> <br /> Journeyman Plumbing license: <br /> <br /> Conh-acinra Board <br /> Regi~ration Number: <br /> <br /> Contractor's Signalum: <br /> <br />~Y: ~'~X~,.-~.$~ s~: 09_ zip: <br /> <br /> I am the PROPERTY OWNER and I reside is or will reside in the completed <br /> s~ntcta~e attd will be my own general contractor. I understand that I must <br /> register as a construction comWtctor if the structure, is ~old or offered for sale <br /> before or upon complellor~ If l hire ~ubcotur~ctor~, [ will hire only <br /> ~beontr~ctors registered with tbe Con~truction Contractors Boar& Ill <br /> change my mihd and do hire a general confractor who is registered with the <br /> Con,ruction Contractors Boar~ I wtll immec~ate~ notify Marion County of <br /> <br />.~ PLAN REVIEW SECTION ' ~ <br /> Marion County does not r~tuire a plan r~vicw. We will provide plan review <br /> servi~ if you complete Section 5B and subm~ two (2) ~ of pisns and <br /> specifications with this application. <br /> <br /> MARION COUNTY BUILDING INSPECTION <br /> 3150 Lancaster Dr. NE - Suite C <br />Salem, Oregon 97305 <br />8:00 am- 4:30 pm 24 hr. Inspection Line 373-4427 FAX 588-794g <br /> <br />4. FEE S~I:I~OULE (Complete and en~r totalin ~-AI ~inw) <br /> <br />( ) RESIDENTIAL ( ) COMMERCIAL ( ) GAS ( ) ELECIRIC <br /> <br />( )NEW ( )ADDITION ( ) ALTERATION ( )RELOCATION <br /> <br />Fl~u-es (New / Alteration) OTY.. QTY. <br /> <br /> Total#Fixtures: x $15.00 = $ <br />-Recomzeet(perfL,'am:e) __ x $7.50 = $__ <br />Lawn Vacaum Breaker __ x $7.50 = $__ <br /> Oth~rVacumnBteakerDevices x $I0.00 = $ <br /> <br />Water Lth~ <br />~Residential;Fimtl00fl.,orfractionthereof x $25.00 = $0~r) <br /> Forcaaddnll00fl, up to S00 feet __ x $16.00 -$ <br /> Commemial:Firstl00t~,orfra~ionthereof __ x $30.00 = $ <br /> Forcaaddn1100feet x $20.00 -$ <br /> <br />Saniinrv Sewer Lines <br />Residential:Firstl00fl.,orfractionthereof ---- x $35.00 = $ <br /> ' Foreaaddnll00fl. up in SOO feet __ x $16.O0 = $ <br />Commercial:Fkst l00 fl., or fraction thereof __ x $35.00 -$ <br /> Foreaaddnll00feet x $20.00 =$ <br /> <br />Sinrm lhrail~ <br />P~sidetflial:Fi~lOOfL, orfractionthereof __ x $35.00 <br /> Foreaaddoll0Ofl, up to S00 feet __ x $16.00 <br />Commerdal:Firstl0OfL, orfractiontheveof __ x $35.00 <br /> Foreaafldn1100feet x $20.00 <br /> <br /> x $10.00 <br /> <br />Dwening Permit Labels <br />(For New Single Family Dwellings Only) <br /> <br />ORe/Two Flintily Dw~llln5 Fee Square Feet: <br />Other (az required by the Building Official) <br /> <br /># of Labels ~ N/C <br /> <br /> x $ .09 = $ <br /> $ <br /> <br />5. FEES <br />Al. BA~E FEE A~es~ed on ALL APPLICATION~: $ 25.00 <br />(Exception: WateffSewor Line Applications w/no fix~ares <br />A2. Enter total Fees from Section g4 $ <br /> SUBTOTAL: $ <br />A3. Add State Surcharge (.05% x A 1 + A2) $ __ <br /> <br />B. Eater 30% of line A1 for Hah Review $ <br />C. Investigation Fee, if required $ __ <br />D. Reinspecfion Fee ($50.00) $ __ <br />E: Additional Plan Review ($62.50/hour, minimum one halfhour) $ __ <br />F. Inspection for which no fee is specifically indicated (S62.50/hr, <br />minimum one hour) $ __ <br />O. inspection Outside Normal Business Hours ($62.50/hr, <br />rain/mum two hours) $ __ <br /> TOTAL AMOUNT DUE $ <br />MC 15145 Rgv <br /> <br /> <br />