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' - -~.' ---2- -- ............................ <br />FOR CITY USE ONLY <br />Received By: Date: <br />Zoning By: City:. <br />Receipt #: Amount: <br /> <br /> I <br />PLUMBING PERMIT APPLICATION l <br /> Please complete all Sections, 1 through $ <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXPIRE lP WORK <br />IS NOT STARTED WITHIN 180 DAYS OF I&~UANCE OR IF <br />WORK IS SUSPENDED FOR 180 DAY~ <br /> <br />2A~ CONTRACTOR INFORMATION <br /> <br />2B. FOR OWNER INSTALLATION <br /> <br /> Property Owner: (pleaseprinO <br /> <br /> Mailing Address: <br /> <br /> City: State: Zip: <br /> <br />I am the PROPERTY OWNER and 1 reside in, or wdi reside in the completed <br />structure and will be my own general contractor. I understand that 1 must <br />register as a construction contractor if the structure is sold or offered for sale <br />before or upon completion, lf I hire subcontractors, 1 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. 1 will immediately notify Marion Coun~ of <br />the name of the contractor: <br /> <br /> Owner's Signature: <br /> <br /> Agent's Signature: <br />3. PLAN REVIEW SECTION <br /> <br />I Marion County does not require a plan review. We will provide plan review <br />service if you complete Section 5B and submit two (2) sets of plans and <br />specifications with this application. <br /> <br />MC 15-45 REV 3/99 <br /> <br /> MARION COUNTY BUILDING INSPECTION <br /> 3150 Lancaster Dr. Nlq. - 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-Al below) <br /> <br />( ) RESIDENTIAL ( ) COMMERCIAL <br />( )NEW ( )ADDITION <br /> <br />Fixtures (New / Alteration) <br />Area Drain <br /> <br />Storm Drains/Rain Draiq,~ <br /> <br />M'mor Installa~ma Labels <br />Pack of 10 labels @ $10.00 *ach, <br /> sold only to Plumbing conlractors) <br /> <br /> OAS ( )ELECTmC <br /> ALTERATION ( ) RELOCATION <br /> <br /> OTY. OTY. <br /> <br />-- interceptor <br />-- Laundry Tub -- <br />-- Receptor <br /> --Shower <br /> Sink <br /> --Trough Drain -- <br /> <br />-- Tub/Shower <br /> Urinal <br /> Water Closet <br /> Water Heater <br /> Other <br /> <br />-- x $15.00=$ 4 <br />-- x $7.50=$ <br />__ x $7.50=$ 1 <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.OO <br />$16.00 <br />$35.00 <br />$20.00 <br /> <br /> x $35.00 =$ 2 <br />x $16.00=$__ <br />x $35.00 = $ <br />-- x $20.00=$__ <br /> <br />-- x $10.00=$__ <br /> <br />-- x $ .09=$__ <br /> <br /> $__ <br /> <br />5. FEES <br /> <br />BASE FEE Assessed on ALL APPLICATIONS: <br />(Exception: Water/Sewc-r Line Applications wino fixtures) <br /> <br /> Al. Enter total of fees from Section ~4 <br /> 3.2, Add State Surcharge (.05% x Al + Base Fcc) <br /> <br />SUBTOTAL <br /> <br />B. Enter 30% of line A1 for Plan Review <br />C. Investigation Fee (if requlred) <br />D. Reinspection Fee ($50.00) <br /> <br /> minimum one-half hour) <br /> Inspection for wMch no fee is specifically indicated, <br /> ($62.50/hr, minimum one hour) <br />O. Inspection Outside Nm'mai Business Hours, <br /> ($62.50fm', minimum two hours) <br /> <br /> TOTAL AMOUNT DUE <br /> <br />$ 25.00 <br /> <br />$__ <br />$ <br />$__ <br /> <br /> <br />