Laserfiche WebLink
FOR CITY VALIDATION [ <br />R~eeived by: <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CEN"I~R <br /> 285 Church St NE · Room 132 PERMIT NO: <br /> Salem, OR 97301 <br /> Date: <br /> <br />24 Hr Inspection Line: 588-7904 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />PERMITS 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 />Contractor's Signature: <br /> <br />2B. FOR OWNBR INSTALLATIONS <br /> <br />Ploperty Owner (p/ease prirg) <br /> <br />Mailing Address Phone <br /> <br />City/Stere/Zip <br /> <br />Agent's Signature: y <br /> <br />3. PLAN KEVIBW SECTION <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 />~C <br /> <br /> .~[E.W I~ ALTERATION ~ADDITION I~'RELOCATION ~ <br /> "GAS ~] or ELP. cIRIC ~" <br />VEC"J'J['}J~/ No. X F~ = Sum <br /> BA~E FEE $10.00 <br /> <br />FORCED AIR FURNACE <br />up to lO0,000 BTU $ 6.00 -- <br />over 160,000 BTU $ 7.00 <br /> <br />Floor Furnace $ 6.00 -- <br />Suspended Heater $ 6,00 __ <br />Wall Heater $ 6.00 __ <br />Floor Mounted Heater $ 6.00 -- <br /> <br />HEAT PL~IP <br /> undor 3 Ton <br /> 3 Ton and up <br /> <br />AIR CONDITIONER <br /> under 3 Ton <br /> 3 Ton and up <br /> <br />EvaporativeCooler <br />Commercial Exhaust System <br />Commercial Hood and Exhaust <br />Domestic Range Hood <br />Domestic Exhaust Fans <br /> and l~3,ex Veins <br />Fire Damper <br />Wood Stove~Fkeplace <br />Furnace Ducts (Alt eration/Ext ~nsion) <br />Commercial / Industrial Incinerator <br /> <br /> 6.50 b.'gO <br />$11.00 -- <br /> <br />$ 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 />$30.00 -- <br /> <br />Gaa Bad~lue <br />Other <br /> <br />$ 7.50 -- <br />$ 7.50 -- <br />$ 7.50 <br />$ 7.50 -- <br /> <br />GAS PIPING SYSTEM <br /> 14 outlets (p~r outlet) <br /> 4 and up outlets (per outlet) <br /> <br />Appliance Vents rot included in <br />an appliance permit <br /> <br />OTHER (as required by Buil~g Ol~cial) <br /> <br />DWELLING PERMrr LABEL # of Labels <br /> <br />$ 2.00 -- <br />$ .50 <br /> <br />$ 3,00 -- <br /> <br />N/C <br /> <br />5. FF~S <br /> A 1. Enter total of fees from Sec.//4 <br /> A2. Add 5,% surcharge (.05 x Al) <br /> <br />Subtotal <br /> <br />B. Enter 25% of lineAl for Plan Review <br /> (Al + .25), if required <br />C. Investigation Fee(ifroquirgd~ DL. ~,~ . <br /> <br /> · ,t~ TOTAL 3u"vlO~ DU]B <br />Receipt No.(~--~ <br /> <br /> <br />