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MARION COUNTY <br />[ _ I BUILDING INSPECTION DMSION PERMIT NO: <br />IFORCITY VALIDATION 3150 Lancaster Dr. NE- Suite C <br />IReceived B I Salem, Oregon 97305-1398 <br />I y; __ -- [ Date:__ <br />|Date: I 24 HR Inspection Line 373-4427 <br />I ~ ~l Office: phone 5880147 8:00~ga - 4:30pm Issued by: <br /> <br /> oWoWo ;s I I I I-I I-I / I¥1 <br />CROSS STREET/ <br />D ONS <br /> <br /> PERMITS ARE NON-TRANSFERABI~ AND EXPIRE IF WORK IS NOT <br /> STARTED WITHIN 180 DAYS OF 1SSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br /> Property Owner (please pfinO <br /> <br /> Mailing Address <br /> <br /> City, State, Zip <br /> <br />3. PLAN REVIEW 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 />BASE FEE ASSESSED ON ALL APPLICATIONS $10.00 <br /> <br />FURNACE OTY <br />FORCEDAIRUPTO 100,(~00BTU x $6,00 =$ <br />FORCED ALR OVER L00,000BTU x $7.00 =$ <br /> <br />FLOOR FIJRNACE x $6.00 = $ -- <br />DUCTS (ALTERATION/EXTENSION) x $7.50 = $ __ <br /> <br />GAS FURNACE (up to IO0,O00BTU) x $6.00 =$__ <br />GAS FURNACE (over 100,0~0 BTU) x $7.00 = $ -- <br />GAS FIREPLACEANSERT x $7.50 = $ __ <br />GAS WATER HEATER x $7.50 = $ -- <br />GAS LOG LIGHTER x $7.50 = $ -- <br />GAS BARBEQUE x $7.50 -- $ __ <br /> <br />GAS PIPING <br />Each ou0et up ~o 4 outlets x $2,00 = $ -- <br />Each additional out[el over 4 o~flets x $.50 = $ __ <br /> <br />HEATERS <br />SUSPENDEDHEATER x $6.00 =$__ <br />WALL HEATER x $6.00 = $ __ <br />FLOOR MOUNTED x $6.00 = $ -- <br /> <br />HEAT P1J1VI~ <br />UNDER3TON x $6.50 =$__ <br />~ aN AND ~OR~ I x $~.oo $ I/. ~0 <br /> <br />5. FEES AL Enter total of fees from Sec. g4 <br /> <br /> A2. Add 5% surcharge (.05 x Al) <br /> <br />B. Enter 25% of Line A 1 for Plan Review <br /> (Al + .25), if required <br />C. Investigation Fee (if required) <br />D. Reinspection Fee ($25.[10) <br /> <br />Receipt No. <br /> <br />Subtotal <br /> <br />TOTAL AMOUNT DUE <br /> <br />MC 15-41 7/97 <br /> <br /> <br />