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08/28/97 THU 08:29 FAX ! 503 588 7948 MAI, b/0N BLDG INSP ~001 <br /> <br /> BUILDING INSPECTION DIVISION ' <br />-i 3150 LANCASTER DR NE - SUITE C ' PERM~ <br />FOR CITY V~IDA~ONI SALEM OREGON 97305-1398 <br />R~civ~ by:_ [~~~ Date; <br /> <br />Pl~e ~~ 1 thr~gh 5 I ~ ' <br />~RION ~ INTY <br />L LOCATIONO~ ~LATION BUILDING INSJ EC~ oF ~UCT~: <br /> <br />PERMITS ARE NON-TRANSF'~EAEL~ AND FaXPIRE IF WORK IS NOT <br />STARTED WITHIN 180 DAYS OF [SSUANC~ OR IP <br /> WORK IS SUSPFaNDED FOR 180 DAYS. <br /> <br />CONTRACTOR IN~rALLATION ONLY <br /> <br />Mailing Address <br /> <br />Plumbing Board: <br />Contractor's Board Reg. No, [ Job No. <br />Journeyman's Plumbem No. <br /> <br />NEW El ALTERATION [3 ADDITION El RELOCATION El <br /> <br />BASE FEE <br /> <br />R~SIDENTIAL (each fixture) <br /> Aurora Dwelling Plumbing Fee <br /> <br />Single Family or multi-family pet <br />dwelling nnit <br /> <br /> Alterations <br /> <br /> Modular Structure <br /> <br /> No. X Fee <br /> <br />__sq. ~. x $.070 <br /> <br />_L_ mlo.oo <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 /> <br />Walcr Lines <br /> First 100 ft, or fraction ther~f <br /> For ea. addn[' [00 fl. <br /> <br />$25.00 <br /> <br />$15.00 <br /> <br />Sanitary & Sto~mn Lincs <br />First 100 ft. or fraction thereof' $30.00 -- <br />For addnl' [00 fL <br /> $15.00 <br /> <br />PROTECTIVE BACKPLOW DEVICE <br />Lawn vacuum breaker (sprinkler system)__ $ 4.50 -- <br />All otheva $10.00 -- <br /> <br />'ost-it' Fax Note 7671 <br /> <br />Rev, 1/96 <br /> <br />Recieved Time Aus.28. 8:30AM <br /> <br />5. FEES <br /> <br />Subtotal <br /> <br /> $ <br />-$ <br /> <br /> S <br /> <br />E. Enter 25% of line Al for Plan Review <br />(Al + ,25), if requlrcd <br />C, Investigation Fee (if required) $ <br />D. R¢ioapcction Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUE $ <br />Receipt No. -- <br /> <br /> <br />