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,~ ~ MARION COUNTY BUILDING INSPECTIOI~ ~ ~. <br /> [-~R CITY VALIDATION [ 285 Church St NE Room 132 <br /> <br /> Office: 588-5147 8:00a.m.-4:30p.m. <br /> <br /> ~PPLICATION 4 FBE $CHBDULE (CompleU~ and enter ~m~low) <br /> [ ~l~ase complete ~!1 ,~ctions, I through 5 ' <br /> USE OF STRUCTURE: ClWe.L.L1 ng <br /> <br />1. LOCATION OF ~qSTALLATION <br /> <br />~obA~ 23660 Meadow Dr NE <br /> <br />c~ Aurora cms~ Arndt Rd <br />~?.yo~.~ Marty Bauman p~ 678-5702 <br /> 2 ton heat pump add-on <br /> <br />PEP, MITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT [ <br />STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />ZA. COHrRACTOR INSTALLATION ONLY <br />~n.e,or 8~8~gHeating & I ~,581-8747 <br />Maili~Address 2365 Front St. NE, Salem, OR <br /> <br />97303 <br /> <br />2B. FOR OWNISR INSTALLATIONS <br /> <br />Property Owner (pl~se £rmt) <br />Mailing Address Phone <br /> <br />City/State/Zip <br /> <br />Owner's Signature: <br /> <br />Agent's Signatoro: <br /> <br /> NEW m ALTERATION ~1 ADDITION ~ RELOCATION <br /> GAS l~ or ELECTRIC ~ <br /> No. X Fe~ = Sum <br />BASE FEE $10~00 <br /> <br />FORCED AIR FURNACE <br /> up to 100,000 BTU <br /> over 1~0.000 BTU~ _ <br /> <br />FloorFumaeo $ 6.00 -- <br />Suspended Heater $ 6.00 -- <br />Wall Heater $ 6.00 __ <br />Fk~or Mounted Heater $ 6.00 -- <br /> <br />6.00 -- <br />7.00 <br /> <br /> HEAT PUMP <br /> under 3 Ton <br /> 3 Ton and up <br /> <br /> AIR CONDITIONER <br /> under 3 Ton <br /> 3 Ton and up <br /> <br /> EvaporativcCaoler <br /> Commercial Exhaust System <br /> Commercial Hood and Exhaust <br /> Domestic R~ge Hood <br /> Domestic Exhaust Fans <br /> and Dryer Vents <br /> Fi~ Damper <br /> Wood StovedFireplaee <br /> Furnace Duets (Aaexation/Ext ~qsion) <br />'-Cb'i~i~ial / Industrial Incinerator <br /> <br />$ 6.50 -- <br />$31.00 -- <br /> <br />$ 6.50 <br />$11.00 -- <br /> <br />$4.50 -- <br />$ 4.50 <br />$4.50 -- <br />$ 4.50 __ <br /> <br />$ 3.00 -- <br />$ 3.00 <br />$ 7.50 -- <br />$ 7.50 -- <br />$30.00 -- <br /> <br />6.50 <br /> <br />ADDITIONAL APPLIANCES Gas Water Heater <br /> Gas Log Lighter <br /> <br /> Othex <br /> <br />GAS PIPING SYSTEM <br /> 1-4 ouflels (per outlet) <br /> 4 and up oullets (per cutle0 <br /> <br />Appliance Vents not included in <br />an appliance permit <br /> <br />OTHER (as requir~d by Stdlditlg Ol~ial) <br /> <br />DWELLING PERMIT LABEL it of Labels <br /> <br />$7.50 -- <br />$ 7.50 __ <br />$7.50 -- <br />$7.5O <br /> <br />$ 2.00 -- <br />$ .50 __ <br /> <br />~C <br /> <br />3. PLAN RBVIEW SRCTION <br /> <br />Marion County does not require a plan review. <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 />1~ 15.41 <br />R~v. 12/94 <br /> <br />5. FE~$ 1 6.50 <br /> Al. Enter tot~lof feez from S~c. ~ $ <br /> A2. Add 5% sur~harg~ (.05 x Al) $ <br /> ~ubtotal $. ' - - <br /> <br /> B. Enter 25% of linc A 1 for Plan Review <br /> (Al + .25), if required $__ <br /> C. Investiga6on Fee (if roquired) <br /> D. Rein~p¢¢tion Fe~ ($25.00) $.__ <br /> 17.33 <br /> TOTAL AMOUNT DUE <br /> R~eipt No. <br /> <br /> <br />