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FOR'CITy USE ONLY ReceivedBy: Date: Zoning By: City: Receipt#: Amount: $ PLUMBING PERMIT APPLICATION Please compile aH Sections, 1 through 5 1. LOCATION OF INSTALLATION Parcel ID: PERMITS ARE NON-TRANSFERaBLE AND EXPIRE IF WORKI IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE OR IF WORK IS SUSPENDED FOR 180 DAFX 2A. CONTRACTOR INFORMATION Contractor: Mailing Address ~ City: State: Zip: Fax: Plumbers License: --'/' Journeyman Pl~b/ng License: ignature: 2B. FOR OWNER INSTALLATION Property Owner: (please print)~.~.~..~ ~_a~ r [-~7~ City:AMfDpo~ State: ~ Zip: ~7~~ 1 ~ the PROPER~ O~ER and I ~ide in, or will ~side in the completed st~ct~e and wiB be my own general contractor. I understa~ that [ must register as a const~ction contractor ~the st~c~re is sold or offer~ for sale before or upon completion, [f l hire su~ontractors, l will hi~ only subcontracto~ registe~ with the Const~ction Contractors Board. lfl change my mind and do hire a genial contractor who is re~stered ~h the Co~t~c~on ~ntractors Boa~, l will immediately not~ Marion County of the name of the contractor: Agent's Signature: 3. PLAN REVIEW SECTION I Marion County does not require a plan review. We will provide plan review I service if you complete Section 5B and submit two (2) sets of plans and spec ficafions w/th th s application. MC 15-45 REV 3/99 MARION COUNTY BUILDING INSPECTION 3150 Lancaster Dn NE - Suite C Salem, Oregon 97305 8:00am - 4:30pm 24 HR Inspection Line 373-4427 FAX 588-7948 4. FEE SCHEDULE (complete and enter total in 5-Al helow) ( I RESIDENTIAL ( ) COMMERCIAL ( )NEW ( )ADDITION Fixtures (New / Alteration) Area Drain Backflow Prevention Device Bathtub Bidet Catch Basin Clothes Washer Dental Unit Cuspidor Drinking Fountain Floor Drain Wet Bar Total g Plxtures Reconnect (per fixture) Lawn Vacuum Breaker ( ) GAS ( ) ELECTRIC ( ) ALTERATION ( ) RELOCATION OTY. OTY. -- Interceptor Laundry Tub -- ~ Receptor -- Shower ~r -- Sink ~ -- Trough Dmin -- -- Tub/Shower j~ Urinal Water Closet ~ Water Heater Other -- x $15.00=$__4 -- x $7.50 = $ -- -- x $7.50=$__1 x $25.00= $__2 x $16.00=$__ x $30.00=$__ x $20.00= $ $35.00= $__2 $16.00= $__ $35.00= $ $20.00= $ x $35.00 x $16.00 x $35.00 __ x $20.00 Minor Installation Labels x $10.00 = $ -- Pack of 10 labels @ $10.00 each, sold only to Plumbing conh'actors) Dwelling Permit Labels #of Labels @ $ NIC (For New Single Family Dwellings Only) On~/Two Family Dwelling Fete Square Feet: x $ .09 = $__ Other (as ~equired by the Building Official) $ -- 5. FEES BASE FEE Assessed on ALL APPLICATIONS: $ 25.00 (Exceplion: Water/Sewer Line Applications w/no fixtures) Al. Enter total of fees from Section #4 $ -- A2. Add State Surchoxge (.~o x Al + Base Fee) $ -- ~ J"l SUBTOTAL $ -- B. Enter 30% of llne Al for Plan Review $ -- C. Investigation Fee (if requireA) $ -- D. Reinspection Fee ($50.00) $ -- E. Addhional Plan RcVxew ($62.SB/hr, minimum one-half hour) $ -- F. Inspection for which no fee is specifically indicated, ($62.50gar, minimum one hour) ~$~ G. Inspection Outside Normal Business Hours, ] ($62.50/hr, minimum two hours) / TOTAL AMOUNT DUE $ --