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FOR Cl'l~ USE ONLY <br />P~ceived By: .Date: <br />Zoning By: City: <br />P~ceipt #: Amount: $__ <br /> <br />PLUMBING PERMIT APPLICATION <br />Please complete all Sections, 1 through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />parcel H): <br /> <br />Site Address: <br /> <br />Project Description: <br /> <br /> PERMITS ARE NON. TRANSFERABLE AND EXPIRE IF WOR~ <br />I IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br />~ WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INFORMATION <br /> <br /> Mai~inggddress: ,~oeT~'-- ~y <br /> <br /> Fax: <br /> <br /> Contractors Board <br /> <br /> 2B. FOR OWNER INSTALLATION <br /> <br />P~pe~J Owner:. (please print) <br />Mailing Address: <br />City: State: <br /> <br />Zip: <br /> <br />I am the PROPERS' OWNER and own, reside in, or will reside in <br />the completed structure and will be my own general contractor. 1 <br />understand that I must register as a construction contractor if the <br />structure is sold or offered for sate before or upon completion. If l <br />hire subcontractors, I wilt hire only subcontractors registered with <br />the Construction Contractors BoanL lfl change my mind and do <br />hire a general contractor who is registered with the Construction <br />Contractors Board, I will Immediately notify Marion County of the <br />name of the contractor. <br /> <br />3. PLAN REVIEW SECTION <br /> <br /> Marion County does not require a plan review. We will provide plan <br /> review service if you complete Section 5B and submit two (2) sets of <br /> plans and specifications with th s app cation. <br /> <br />MC 15-45 Rev 9/98 <br /> <br /> MARION COUNTY BUILDING INSPECTION <br /> 3150 Lancaster Dr. brE. Suite C <br />Salem, Oregon 97305 <br />8:00am - 4:30pm 24 HR Inspection Line 373-4427 FAX 588-7948 <br /> <br /> L ~ SCHEDULE (complete nnd enter total in 5-Al below) <br /> (~)RESIDENTIAL ( )COMMERCIAL ( )GAS ( )ELECTPdC <br /> <br /> NEW ~ADD~TION (,) AL'[~ATION ( ) RELOCATION <br /> <br />T~al#Fixtu~s ~ x $15.00 =$ ~ 4 <br /> <br />MIm~rlmtoRstloaLab~ -- x $10.00=$__ <br />~ack of 10 labels @ $10.00 each, <br />~ ~ly ~ Plumbing con.mm) <br /> <br />Dw~ ~t La~ ~ ~ls ~ $ ~ <br />~or New Single F~y ~ell~ ~y) <br /> <br />~F~F~:~ ~ x $ .~=$~ <br />~ (~ ~ by ~ Buil~ ~) $ ~ <br /> <br />RASE FEE Assessed on ALL .4~PLICA~'IONS: <br />(l~xcelRion: Watex/Sewer ~ Applications w/no fixtures) <br /> <br /> Al. Enter tDtal of fees from Section ~4 <br /> A2. Add State Sureharg~ (.05% x Al + Bas~ Fee) <br /> <br />SUBTOTAL <br /> <br />B. Enter 30% of line A1 f~r Plan Review <br />C. Investigation Fee (ff rexluir~d) <br />D. Relnsp~ctlon Pee ($50.00) <br />E. Additional Plan Review ($62.50/hr, <br />mi~num one-half hour) $ -- <br />E Inspection for which no fee is specifically indicated, <br />($62.50/hx, minlmm'a rn~ hoax) $ -- <br />13. Inspection Outside Nonmfl Business Hours, <br />($62.50/hr, tab,mum two hours) $ __ <br /> <br /> TOTAL AMOUNT DDE $ __ <br /> <br /> <br />