Laserfiche WebLink
FOR CITY USE ONLY <br />Received By: Da~: <br />Zoning By:. Cily: <br />R~c~ipt #: Amount:$ <br /> <br />NOV 2 - 1995 < )A DmoN <br />MARION C01 ~n <br /> <br />MARION COUNTY BUILDING INSPECTION <br />COMMUNITY DEVELOPMENT CENTER <br />3150 Lancaster D~, NE - Suite C, Salem, Oregon 97305 <br /> S:00 am - 4:30 pm <br /> 24hr. Inspectio. Line 37 .4427 FAX,gS-?~4S 9~-- /~q~ 7 q <br /> P ~~ 4, FEESCItEDULE(completoanden~rtotalinA1) <br /> ( ) OAS ( ) EL~CTP~C <br /> ( ) ALTERATION <br /> <br />pERMIT~ ARE NON. TRANSFERABLE AND D~IRE IF WOR~ <br /> NOT STARTED F~ITHIN 180 DA I~ OF ISSUANCE OR IF <br />WOR~ 15 SUSPENDED FOR 180 DAY~. <br /> <br />2A. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS <br />DOING THE WORK <br /> <br />Mailing Address: <br />City: Stale: Zip: <br />Phone; Fax: <br /> <br />I am the PROPER1T OWNER and ow~ reside i~. or will reside in the <br />completed ~ctore and will be my own general contmcWr. I understand <br />that I must register as a construction contractor if the structure i$ told or <br />o~red for ~de before or upon completior~ lfI hire a'ubcontr~tore, I will <br /> <br /> Agent's Signature: <br /> <br />3. PLAN REVIEW SECTION <br /> <br /> Marion County does not requir~ a plan r~view. We will provide plan review <br /> service if you ~omplete Section 5B and submit two (2) sets o f plao.~ and <br /> specifications wilh this application. <br /> <br />MC 15-41 Rev 9/98 <br /> <br />( ) RELOCATION ( ) REPLACEMENT <br /> <br />Furnace (Includes duets I ven~) <br />For~ed Ah' up to 100,0~0 BTU <br />Forced Air over 100,000 BTU <br />Hoer Furnace <br />Duc~ (Alterationa/Extans~n) <br /> <br />OTY <br /> <br /> x S12.00 = S <br /> x $15.00 = S <br />-- x $12.00 = $ <br /> x $15.00 = $ <br /> <br />Gas Ins~din~ion <br />Gas Furnace (up to 100,000 BTU) <br />Gas Furnace (ov~r 100,OO0 BTU) <br />Oas Fireplace / Insert <br />Gas Water Heart <br />O~ Log Lighter <br />Gas Bmbcquc <br />c~ Pipes <br />Each outlet up to 4 outlets <br />Each additional outlet over 4 outlets <br /> <br />x $12.00 = $ <br />x S15,00 = $ <br />x S15.00 = $ <br />x $15.00 = $ <br />x $15.00 = S <br />x $15.00 = $ <br /> <br /> x S 4.00 = $ <br /> x $ 1.00=$ <br /> <br />x S12.00 = S <br />x $12.00 = $ <br />x $12.0~ = $ <br /> <br />H~at Prone <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 More <br />Evaporative Cooler <br /> <br />x $15.00 = $ <br />x $22.00 = $ <br />x $ 9.00 = $ <br /> <br />Domestic Dryer Vents <br />Appliance Voms installed and <br /> <br />x $9.00 =$ <br />x $9.00= $ <br />x $%00= $ <br />x $6.00= $ <br />x $6.00= $ <br /> <br />x $6.00= $ <br /> <br />A&ll~onnl AnnlLeacea <br />Wood~ove / Fireplace <br />Fire Damper <br />Coral / Industrial Incinerator <br /> <br />x $15.00 = ~ <br />x $ 6.00 = $ <br />x $60.00 = $ <br /> <br />Oneffwo Family Dwelling Fee Square Fe~t: -- x $ .04 = $ <br />Dwe~ Permit Lal~qs # of Labels -- <br />(For New Dwellinga Only) <br />Oth~ (as required by the Building Official) $ <br /> <br />5. FEES <br />Al. BA~E FEE Assessed on ALL APPLICATION~: $ 25.00 <br />A2. EntorTutal Fees from Section #4 $ <br /> SUBTOTAL $ <br />A3 Add State Surcharge (.05% x A1 +A2) $ <br /> <br />B. Enter .30% of line A1 for Plan Review <br />C. Investigation Fee, ffreqinred <br />D. Reinspectinn Fee ($50.00) <br />E. Additional Plan Review, $62.50/hour, ( minimum one half hour) <br />F. Inspection for which no fee is specifically indicatod, $62.50/hr, <br /> (minimum one hour) <br />G. Inspection Outside Normal Business Houes, $62.50/hr, <br /> (minimum two hours) <br />H. Seismic Fee (.01% x Al) <br /> TOTAL AMOUNT DUE <br /> <br /> <br />