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FOR CITY VALIDATION[ <br />Reczived by: I <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br />COMMUNITY DEVELOPMENT CENTER <br />285 Church St NE · Room 132 <br /> Salem, OR 97301 <br /> <br /> 24 hr. Inspe~ton Line 373-442? <br />Office <br /> <br />Date: <br /> <br />Pho.~[~:3Opm Issued by: <br /> <br /> MABION -n,,u.v RE~DENTIAL [~ COMMERCIAL [-~ <br /> · uu~j~. OF STRUCTURE: -- <br /> BUll. DINS [SP~ALTERATION O ADDITION O RELOCATION <br /> <br /> 1. LOCATION OF INSTALLATION <br /> <br /> -~ <br /> <br />~ A~ NON-~S~BLE A~ ~ IF WORK IS NOT [ <br /> I <br /> ~ ~ 1~ DAYS OF ISSU~ OR ~ <br /> WO~ ~ SUS~D~ FOR 1~ DAYS. <br /> <br /> ~. CO~CTOR ~LATION O~Y <br /> <br /> ~ntracmr'a ~a~ ~, No. Job No, <br /> <br />za. FOR owNRR_ U.-STALI.ATION$ <br /> <br />Property Owner (pleaso pried) <br /> <br />Mailing Addr~s Phone <br />City/State2Zip <br />Owner's Si~nat ufo: <br />Ag~/Wa 5{gfmturc: <br /> <br /> GAS ~] or ELECTRIC 0 <br /> No. X Fee = Sum <br />BASE FEE $10.00 <br /> <br />FORCED AIR FURNACE { L~ <br /> up ~o 100.000 BTU $ 6.00 <br /> ov~ 10~,000 BTU $ 7.00 <br /> <br />Floor Furnace $ 6.00 -- <br />Suspended Heater $ 6.00 <br />Wall Hea~er $ 6.00 <br />Floor Mouutcd Heater $ 6.00 <br /> <br />HEAT PUIVIP <br /> under 3 Ton <br /> 3 Ton and up <br /> <br />AIR COI~)ITIOI~a{R <br /> u~der 3 Ton <br /> 3 Ton and up <br /> <br />EvaporativeCoolcr <br /> <br />Wood Stove/Flrepla~ <br /> <br />Gas Log Lighter <br />Oa~ Ba~,qu~ <br /> <br />GAS PIPING SYSTEM <br /> 1-4 oude~ (per outle0 <br /> 4 and up outlcls (~r outlet) <br /> <br />$ 6,50 . <br />SILO0 <br /> <br />$ 6.$0 <br />$11.00 . <br /> <br />$ 4.50 <br />$4.50 <br />$ 4.50 <br /> <br />$4.50 <br /> <br />$ 3.00 <br />$ 3.00 <br />$7.50 <br />$ 7,5O <br /> <br />$ 7.50 <br />$7.5O <br />$ 7.5O <br />$7.5O <br /> <br />$ 2.00 <br />$ 30 <br /> <br />$ 3.~0 <br /> <br />3. PLANRBVIEW 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 />MC 1541 <br />REV 8~96 <br /> <br />5. FF~$ <br /> A 1. Unter total of f~s from S~c./t4 S~ <br /> A2. Add 5% surcharge (.05 x Al) <br /> $ <br /> $ <br /> <br /> B. Eater 25% of liAe A 1 for P~ R~ew <br /> (Al + .25), if m~i~ $.~ <br /> C, ~v~tigation Fee (if~u~d) $ <br /> D. Reimpeotion ~ (~.~) $ <br /> <br /> TOT~ ~O~ D~ <br /> R~eipt <br /> <br /> <br />