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{FO]crr¥ VALIDA~ON{ Ms Ch,~,~h St ~E- Room 1212 <br /> <br /> Reeolved b~: -- Salem, OR 972101 <br /> Dato: 24 hr. Inspection Line 373-4427 <br /> Office: Phone 588-5147 8:00am - 4:30pm <br /> FAX: 588-7948 <br /> <br />COMMUNiTY DEVELOPMENT CENTER PERMIT NO: *-' <br /> Date: <br /> Issued by: <br /> <br />easPLUMBING pERMIT APPLICATION <br /> e complete all ~ectlons, I through <br /> <br /> OCATION OF I~ISTALLATION <br /> <br />PERMITS ARE NON-TRANSFERABLR AND I~(PIRE IF WORK IS NOT <br />STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR IiqSTALLATION ONLY <br /> <br /> lvhiling Add~s <br /> <br />Plumbing Beard: <br />Contrnclor's lkmrd Reg. No. ] Job No. <br />Joum~-yman's Plurabe~ No. <br />. Comraetor'a Signature: <br /> <br />~.~OR OWN'ER INSTALLATIONS <br /> Prop~rty Owa~ (ple~s~ pri~t) ~lO.~l-[j ~ <br /> <br /> A~t'a si~: ~ <br /> <br />3. PLANR.B¥1BW SBCTION <br /> <br />Marion County does not require a plan review. <br />We will provide plau review service if you complete <br />Section 5B and submit two (2) sets of plans and <br />specifications with this apPlicati0fl~ <br /> <br />MC 1545 <br />Rev. 1/96 <br /> <br /> FI{R SCH]{DUL]{ (Complete nnd enter total in At below) <br /> <br /> RESIDENTIAL ~ COMMERCIAL <br />USE OF :~I'RUCTURI~: <br />NEW 12 ALTERATION r, ADDITION [2 RI~OCATION <br /> <br />BASE FEE <br /> <br />RI~NTIAL <br /> Aurora Dwe{{ing Plumbin~ Fee ..... sq R x $ 070 <br /> <br />Single Family ~ muhi-faimiy per <br />dwelling unit <br />New ~ons~uction $10.00 <br />A~.~o. 2~ $~o.oo~D <br />Reconnect $ <br />Relo~.~d Slmctum $ 5.00 <br />l~d~hr Structure $ 5.00 <br /> <br />Fu~t 100 ft. or fraction lhe~of $20.00 <br />For ea. adda{' 100 ft. (up to <br />maximum of 500 ft.) $15.00 <br /> <br />maximum of S00 fl.) $15.00 -- <br />Alt~ratiom $10,00 <br /> <br />Fimt 100 ft. or fraction ~hereof $25,00 -- <br />For ea. addal' 100 ft. <br /> $15.00 <br /> <br />Sanitary & Storm Linem <br />Vtmt 100 ft. or fr~¢tion Ihoreof $30,00 -- <br />For nddnl' 100 ft. <br /> $15.00 <br /> <br />PROTECTIVE BACKFLOW DEVICE <br /> Lawn vacmmm breaker (sprinkler system) <br /> All others <br /> <br />$ 4.~0 <br />$10.00 -- <br /> <br />OTHER (as reqait~d by 05P5C <br /> and BuildJ,~g O~cial) <br /> <br />DWELLING PI/RMIT LABEL # of Labels <br /> <br />5. FBBS <br /> Al. Enter totaloffeo~ fwm Sec./~4 <br /> A2. Add5% su~hnrg~ (.05 x Al) <br /> Subtotal <br /> <br /> B. Enter 25% of line A 1 for Plan Review <br /> (A 1 + ~?.5), if required_ <br /> C. Inv~stigatio~ 1~ (if ~lulre2) <br /> D. Reinspection Fee ($'25.00) <br /> <br /> TOTAL AMOUNT DUB <br /> Enc~ipt No. <br /> <br /> <br />