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FOR C~TY USE ~NLY <br />Recolved By: .Date: <br />Zoning By: .City: <br />Receipt #: Amount: $_ <br /> <br />1. LOCATION OF INSTALLATION <br />Parcel ID: <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK <br />IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br />WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INFORMATION -- PLEASE INDICATE <br />WHO IS DOING THE WORK <br /> <br />Propeay Owner: (p/ease print) <br />Mailing Address: <br />City: State: Zip: <br />Phone: Fax: <br /> <br />I am the PROPERTY OWNER and own, reside in, or will reside in <br />the completed structure and will be my own general contractor. 1 <br />understand that I must register as a construction contractor if the <br />structure is sold or affered for sale before or upon completion. If l <br />hire subcontractors, I will hire only subcontractors registered with <br />the Construction Contractors Boar& If l change my mind and do <br />hire a general contractor who is registered with the Construction <br />Contractors Board I will immediately notiJ~ Marion Coun~ of tbe <br />name of the contractor. <br /> <br /> Owner's Signature: <br /> <br /> Agent's Signature: <br /> <br />3. PLAN REVIEW SECTION <br /> <br />Marion County does not require a plan review. We will provide plan I <br />review service if you complete Section 5B and submit two (2) sets of <br />p aris and spec ficat OhS with th s app cation. <br /> <br />MC 1541 Rev 9/98 <br /> <br />MARION COUNTY BUILDING INSPECTION <br />COMMUNITY DEVELOPIVIENT CENTER <br />3150 Lancaster Dr. NE - Suite C, Salem, Oregon 97305 <br />8:00am - 4:30pm <br />24 HR Inspection Line 373-4427 FAX 588-7948 <br /> <br />4. FEE SCHEDULE (complete and enter ~ in Al) <br /> <br />/ <br />( ~fRESIDENTIAL ( ) COMMERCIAL <br />( ) N~W ( ) ~DDmO~ <br />( ) RELOCATION ( ) REPLACEMENT <br /> <br />ltm-nac~ (teeludes ducts / vents) <br />Forced Air up to 100,000 BTU <br />F~ced Ak over 100,000 BTU <br />Floor Furnace <br />Ducts (AIterationrdExtenaion) <br /> <br />Gas Installation <br />Oas Furnace (up to 100,000 BTU) <br />Gas Furnace (over 100,000 BTU) <br />Gas Fireplace ! lnser~ ~-~5 ~'C'OX/~- <br />Oas Water Heater <br />Oas Log Lighter <br />Gas Barbeque <br /> <br />Gas Piping <br /> Each outlet up to 4 oudets <br /> Each additional outlet over 4 outl~s <br /> <br />Heaters <br />Suspe~ Ee~ter <br /> <br />~s ( ) ~n~c <br /> ALTERATION <br /> <br />-- x $12.00=$__ <br />-- x $15.00=$__ <br />-- x $12.00=$__ <br />-- x $15,00=$__ <br /> <br />-- x $12.00=$__ <br />x $15.00 = $ <br /> <br />-- x $15.00=$__ <br />-- x $15.00=$__ <br /> <br />-- x $1.00 = $__ <br /> <br />-- x $12.00=$__ <br />-- x $12.00=$__ <br />-- x $12.00=$__ <br /> <br />-- x $22.00=$__ <br /> <br />-- x $15.00=$__ <br />-- x $22.00=$__ <br />-- x $9.00 = $__ <br /> <br />__ x $9.00=$__ <br />-- x $9.~0 = $__ <br />-- x $9.~0 = $__ <br />-- x $6.00 = $__ <br />-- x $6.00 = $__ <br /> <br />__ x $6.00=$__ <br /> <br />x $15.00=$__ <br />__ x $6.00 -- $__ <br />__ x $60.00=$__ <br /> <br /> x $ .04=$__ <br /> <br /> #of La~ls __.@ $ N/C <br /> <br />BASE FEE Assessed on ALL APPLICATIONS: Al. Enter total of fees from Sec, g4 <br /> <br /> A2. Add State Suwhat,ge (~05% x A1 + Base Fee) <br /> <br />B. Enter 30% of line A1 for Plan Review <br />C. Investigation Fcc (if required) <br />D. Reinspecton Fee ($50.00) <br />E. Additional Plan Review <br /> minimum one-half hour) <br />E Inspection for which no fee is specifically indicated,(~ <br /> ($62,50/hr, minimum one hour) <br />G. Inspection Outald¢ Normal Business Hours, <br /> ($62.50&r, minimum two hours) <br />H. Seismic F~e (.01% x Al)) <br /> <br />TOTAL AMOUNT DUE $ -- <br /> <br /> <br />