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~ MARION COUNTY BUILDING INSPECTION <br />FOR CITY USF ,ONLY ~ COMMUNITY DEVELOPMENT CENTER <br />P. eceive64~/: ~1~ Date: i 3 I50 Lancaster Dr. NE- Sui~ C. ~alem, Oregon 97305 <br />Zoning By:_ City: I~ 8:00 am - 4:3~ pm ~'~ <br />Receipt #: Amoum'.$ , 24 hr.~~T3 '7~7 FAX ' SS-794~ ~. ~ ~ ~1~ <br /> <br /> · , [~) 4. FEESCHEDULE(¢mplete~ndentorto~allnA1) <br />· mC~t~NI¢^LPER~TAPFUCAT~O~ NOV 2" fgq~7 .~.P~__.tD~rnAr ( )COMMEECt~ <br /> pl~secomple~all$~flons, lthrough$ ] '~ ~NEW ( )ADDITION <br /> MARION COUNTY (')~£~OCATIO~ ( ~P~Cm~S~ <br /> <br />PERM1T~ AP~ NON-TRANSFERABLE AND ET(P/RE IF WORff <br />IS lV'OT b'TARTED F/ITH/N I~0 DA I~' OF ISSUANCE OR IF <br />WOR~ 15 SUSPENDED FOR 1~0 DAYS. <br /> <br />2A. CONTRACTOR INFORMATION -- PLEASE INDICATE WItO IS <br />DOING THE WORK <br /> <br />M~iling Address: <br /> <br />City: Sta~: <br /> <br />offered for sale before or upon <br />hint only subcontnactors ~ <br />If l~hange no <br />the ~ <br />of the name of the contractor: <br /> <br />or will reticle in the <br /> <br />l will immediately notify Marion County <br /> <br /> Ovmer's Signature: <br /> <br /> Agent's Signature: <br /> <br />3. PLAN REVIEW SECFION <br /> <br />Mas/on County does not r~quire a plan review. We wiR provide plan review <br />service if you complete Section 5B and submit two (2) sets of plans and <br />specificatiom wi~h this application. <br /> <br />MC 15-41 Rev 9/98 <br /> <br />Furnace (h~ludea daces / vents) <br />Forced Air up to 100,000 BTU <br />Forced Air over 100,000 BTU <br />Floor Furnace <br />Duc~ (Al~rafions/Extensinn) <br /> <br />x $12.00 = $1~7 <br />x $15.00 = $ <br />x $12,00 = $ <br />x $15.00 = $ <br /> <br />Gas Fumac~ (up to 100,000 BTU) <br />Ga~ F~ (over 100,000 BTU) <br /> <br />Gas Log Liglaer <br />Gas Barb~que <br />Gas Piping <br />Each outlet up to 4 outlets <br />Each additional outlet over 4 outlets <br /> <br />x $12.00 = S <br />x $15.00 = $ <br />x $t5.00 = $ <br />x $15.00 = $ <br />x $15.00 - $ <br />x $15.00 = $ <br /> <br /> x $4.00=$ <br /> x$ LO0=$ <br /> <br />x $12.00 = $ <br />x $12.00 = S <br />x $12.00 = $ <br /> <br />He~t Pumn <br />Under 3 Ton <br />3 Ton and Mor~ <br /> <br />x $12.00 <br />x $22.00 <br /> <br />Air Conditioner <br />Under 3 Ton <br />3 Ton and Mor~ <br />Evaporative Cooler <br /> <br />$15.00 = S[~'"" <br />$22.00 = $ <br />$ 9.00 = $ <br /> <br />Domestic Range Hood (includes ducts) <br />Dom~atic l)~yer Vents <br /> <br />x $9.00 =$ <br />x $ 9.00 = $ <br />x $ 9.00 = $ <br />x $ 6.00 = $ <br />x $6.00 = $ <br /> <br />x $6.00 = $ <br /> <br />Damper <br /> <br />x $15.00 = $ <br />x $6.00= $ <br />x $60.00 = $ <br /> <br />One/Two Family Dwellin~ Fee Square FeeC __ x $ .04 = $ <br />DweBln~PermltLabels #of Labels __~ $ N/C <br />(For New Dwellings Oaly) <br />Other (as required by the Building Official) $ <br /> <br />,~ FEES <br />Al. BASE FEE A~sed on ALL APPL!CA TION~: <br />A2. EmerTotal Fees from Section//4 <br /> SUBTOTAL <br />A3 Add State Surcharge (.05% x Al +A2) <br /> <br />B. Enter .30% of line A1 for Plan Review <br />C. Investigation Fee, ifrequirod <br />D. Reinspection Fee ($50,00) <br />E. Additional Plan Review, $62.50/hour, ( minimum one half hour) <br />F. Imp~tinn for which no f~ is speeific~ally indicated, $62.50/hr, <br /> (minimum one hour) <br />O. Inspection Outside Normal Business Hours, $62.50/hr, <br /> (minimum two hours) <br />H. Seismic Fee (.01% x Al) <br /> <br />$ 25.OO <br />$ <br /> <br /> $ <br />TOTAL AMOLrNT DUE ~1~ <br /> <br /> <br />