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FOR CITY VALIDATION <br /> <br />Date: <br /> <br /> Please complete all ~ections, I throug~oN COUNT <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> PERMIT NO: <br /> <br />COMMUNiTY DEVELOPMENT CENTER <br />285 Church St NE · Room 132 <br /> Salem, OR 97301 <br /> <br /> :30pm <br /> <br />BUILDING INSPEG1 <br /> <br />Date: <br /> <br />Issued by: <br /> <br />lob Addr~s Z! <br /> <br />APE NON-TIL~SF~LE AiN3D EXI~ IF WORK IS NOT <br /> STARTI~ ~ 180 DAYS OF ISSU/~aNCE OR IF <br /> WORK IS SUSPEHDED FOR 180 DAYS. <br /> <br />CONTRACTOR INSTALLATION ONLY <br /> <br />Phone <br /> <br />BASE FEE <br /> <br />FORCED AIR FURNACE <br /> up to 100,000 BTU <br /> over 100,000 BTU <br /> <br />Suspended Heater <br />Wall Heater <br /> <br />No. X Fee - Sum <br /> $10.~0 <br /> <br />Contractor's Lic~se No. <br /> <br />2B. FOR OWNltK INSTALLATIONS <br /> <br />Ptopen'y Owner (ple~sepri~t) <br /> <br />Mailing Addre~ Phone <br />City/State/Zip <br />Owner's Signature: <br />Apent's Signature: <br /> <br />3. PLANR~VIBW SHCTION <br /> <br />Marion County does not require a plan review. <br />We will provide plan review service if you complete <br />Section 5B and submit two (2) sets of plans and <br />specifications with this application. <br /> <br />MC 15-41 <br />REV 8/96 <br /> <br />Commercial Hood and Exhaust <br /> <br />GAS PIPING SYSTEM <br /> 1-4 outlets (per OUll~0 <br /> 4 and up outlets (per outlet) <br /> <br />Appliance Vents not included in <br />an appliance permit <br /> <br />OTHER (as requited by Btdl~t~g Ol~cial) <br /> <br />DWELLING PERMIT LABEL #of Labels <br /> <br />$ 3.00 -- <br /> <br />N/C <br /> <br />5. FI~IS Al. Enter total of fee~ from See. #4 <br /> A2. Add 5% surcharge (.05 x Al) <br /> <br />~ubtotal <br /> <br />B, Enter 25% of line Al for Plan Review <br /> (Al + .25), if required <br />C. lnvestlgationFee (if required) <br />D. Reinspection Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br />Receipt No, <br /> <br />$ 6.00 -- <br />$ 7.00 <br /> <br />$ 6.00 -- <br />$ 5.0O -- <br />$ 6.00 -- <br />$ 6.0o __ <br /> <br />$ 6.50 <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.OO <br />$7.5O __ <br />$ 7.5O <br /> <br />$ 7.50 -- <br />$ 7.50 -- <br />$7.50 __ <br />$7.50 -- <br /> <br />$ 2.00 -- <br />$ 30 <br /> <br /> 4. FIiR SCH]~F)ULIi (complete andenter totalinAl below) <br /> <br /> N RESIDENTIAL ~ , <br /> COI~MERCIAL <br />0 USE OF STRUCTURe: <br /> NEW rn ALTERATION [~.ADDITION t~I~OCATION n <br /> GAS (~ or ELECTRIC ,~ <br /> <br /> <br />