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TUE 1711~ FA~ 1 50~ 588 7948 <br /> <br />EARION BLDG INSP <br /> <br />2A. CONTRACTOR INFORMATION -- P~ IIqD'rCA'Ii~ <br />WltO I~ DOING ~ WORK <br /> <br />~g Ad'ss; <br />~ty: 8L~: Zip: <br /> <br />;~ completed ~t~c~ a~ will b~ m~ o~ ~cn~r~ <br /> <br />~cture is ~OM or offm~d ~r a~e bffo~ or upon <br />hi~ su~olurac~r~, I will hi~ only ;~a~cwra <br />the Co~ct~n Co~rac~n B~. I/I C~m ~ <br /> <br /> MA.EtlON COUNTY BUILDII~TG INSPECTION <br /> <br />150 ~e,r Dr. }il! - Sult~ C, Salem, Or*god ~/305 <br />8;00~m - 4;30pm <br />24 HR Inspection L~e 373.4427 FAX 558-7948 <br /> <br />~ Oucl~u duc~ 1 v~) <br />Fom~l AIr u¢ m 100,000 BTO , x <br />For~d Ah' ov~ [ 00,000 BTU __ x <br /> <br />O~ I~rna~ (up to 100,000 BTU) ~ x $12.00 = S <br /> <br />Ou Log Li~r x $15.00 = $__ <br />Gu B~be4ao x $L$.00 ,- $_ <br /> <br />Plooe Mou~ad H*at~. x $12,00 = S <br /> <br />Under 3 Ton x $12.~ = S__ <br />3 T~ md Mc~o , x <br /> <br />~ilr ~..o~ditloner <br />gad~r 3 Ton x <br />S Tc~ ~ Mom x $22,00 = S __ <br />llwpm'~dw C00ldr x $9,00 = $ __ <br /> <br />Co~ gxi~u~t n~,~tem x $9.00. $ __ <br />~ 1,I~ &.Enlmut x &9.00 = $ <br />D~.~i; l~ml~ lt~od Cl~olud~ ddeu) x $9.o0 =S --~::- <br /> <br />~flc ~ ~ ' x ~,~ = S __ <br />Ap~i~ ~nm ln~l~ ~d <br /> <br />W~gov*/P~pl~ i x 515.00=$__ <br /> <br />Dw~ Pa~t L~ ~ ~ ~ $ ~ <br /> <br />BASE F,~ Az~msstd on ~ AJ:PLICATION$: $ <br /> Al. Enter loll of f~N from Soo. ii4 <br /> Al. Add Su. te Su~hargo (.05% x Al + BBC F~) <br /> <br />IL Enter S0~ of ~ Al for PL~ P~ vt~v <br /> <br />E, a~Jid~id PLan P,~vl*w <br /> <br />F. Ill~l~oti~t f~r whJ~ ~ fc~ I, ,lXlCifimtlll/j~lo~id, .~ <br /> <br />$__ <br />$ <br />5__ <br />$__ <br />$ __ <br /> <br /> <br />