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FOR CITY VALIDATION <br />RD~;i:wd by: <br /> <br />COMMUNITY DEVELOPMENT CENTER ~ '/ <br />285 Church St NE · Room 132 PERMIT NO: <br />Salem, OR 97301 <br /> Date: <br /> <br />24 Hr Inspe, ction LJ, n~: 5811-7904 <br />Office: 588-514.7 8:00a.m,-4:30pJn. <br />FAX: 588-7948 <br /> <br />PLUMBING PERMIT APPLICATION <br />Please complete ali Sections, I through 5 <br /> <br />1, LOCATION OF INSTALLATION <br /> <br /> STARED ~THIN 1 ~ DAYS O~ ISSU~ OR IF; <br /> WORK IS SUSP~D~ FOR 1~ DAY$. <br /> <br />CO~RACTOR ~ST~LATION <br /> <br />Marion County does not require a plan revigw. <br />We will provide plan review service if you complete <br />Section 5B and submit two (2) sets of plans and <br />specifications with this application. <br /> <br />MC 15-4.5 <br /> <br /> Issued J;Lv: ~ <br /> <br />4. Fl:lB SCHEDULE (Complete and enter total in A I below) <br /> <br /> R$ISIDI~NTIAL [] C O1VIMI/RC IAL ~:f', <br /> USI~ OF STRUCTU:RE: <br /> NEW rq ALTERATION ~1 ADDITION [~ RELOCATIO/N~--.. <br /> l_%,,_~-- <br /> Fe~ - Sum <br />BASE FEE No. X (- $2~'.0~ <br />RESIDENTIAL (each fixture) <br /> <br /> Aurora Dwelliilg Plumbing Fee <br /> <br />Single Family or multi-t;amily per <br />dw~lling unit <br /> New construction <br /> Alterations <br /> Reconnect <br /> <br /> Modular Smmtur¢ <br /> <br />Water Lin*s <br /> Fimt 100 fl, or traction thereof <br /> For ea. ad~l' i00 R, (up to <br /> rmmimum of 500 ti,) <br /> <br />Sanita~ & Storm Lines <br /> <br />__ aq, fL, x $,065 = <br /> <br />$10.00 <br />$10.00 <br />$ 5.00 <br />$ 5,00 <br />$ 5.00 <br /> <br />$20,00 <br /> <br />$15.00 <br /> <br />$30.00 <br /> <br />$15.00 <br /> <br />$10.00 <br />$10,fi0 <br /> <br />For addnl' 100 ft. <br /> <br />$25,00 <br /> <br />$15.00 <br /> <br />$30,00 <br /> <br />$15.00 <br /> <br />PROTECTIVE BACKFLOW DEVICE <br /> Lawn vacuum breaker (sprinkler system).__ <br /> All oth*m <br /> <br />OTHER (os lvqnimd by O&*$¢ <br /> and Building OtIi¢iaO <br /> <br />DWELLINO PERMIT LABEL <br /> <br />#of Labels <br /> <br />$ 4.50 <br />$10.00 , , <br /> <br />FEI~$ <br />Al. Fmtcr total offeca from S~.//4 <br />A2, Add 5% aurchargo (,05 x Al) <br /> Subtotnl <br /> <br />B, Entor Z5% of line A 1 ibc Plan Rovi~w.. <br /> (Al + ,25), if ~quired <br />C, l~ve$figatlon Foo (if~quimd) <br />D. Reimpegtion Fee <br /> <br /> TOT~ ~O~ DUE <br />Receipt No, <br /> <br />$°° <br />s <br /> <br /> <br />