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P~I~ ~ NON.~SF~ ~D ~1~ IF WO~ <br /> NOT ST~T~ W~HIN 1~ DA~ OF ISSU~CB OR IF <br /> 15 5USPBNDBD FOR 180 DA~. <br /> <br />2A. CONTRACTOR INFORMATION -- PLEASE INDICATE <br />WHO IS DOING THE WORK <br /> <br />PrOlnn~ Owam~. (please p~qnt) <br /> <br />Mailing Add~s~: <br />City: Sram: Zip: <br /> <br />I am the PROPERI'g OWNER and own, reside in, or ]yill reside in <br />tbe completed structure and will be my own general contractor. 1 <br />understand that I must register a~ a conttruction contractor ~f tt~ <br />structure i~ sold or offontd for ~ before or upon completiot~ Ill <br />h~re saheontractor~, l will hire only subcontractors registered with <br />the Con~tnwtion Contractor~ Baan~ If I change my mind and do <br />hire a general contractor who i~ regi~ered with the Construction <br />Contractors Boar~ I will immediately notify Ma~qon County of tbe <br />name of the contractor. <br /> <br />Owr~'s Signature: <br /> <br />3. PLAN REVIEW SECTION <br /> <br /> Marion County do~ not r~quire a plan review. We will pmvid~ plan <br /> review servic~ if you compl~t~ Section 5B and submit two (2) ~ of <br /> plans and specifications with this application. <br /> <br />MC 15~.I R~v 9/98 <br /> <br />MARION COUNTY BUILDING INSPECTION <br />COMMUNITY DEVELOPMENT 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 /> ( )RESIDENTIAL (/~COIVIIVfl~CIAL (/.~GAS ( )ElECTRiC <br /> <br />( ) NEW ( ) ADDITION ( ) ALTERATION <br />( ) ~TION ( ) REPLA~ <br /> <br />~ (includ~ dnc~ I <br />For~d Air up to l00,000 BTU -- x $12.~0=$__ <br />Forcml Air ov~100,000 BTU -- x $15.00=$__ <br />FloorFumace -- x $12.00=$__ <br />Duct~ (Alm'ations/Extension) -- x $15.00 = S __ <br /> <br />GaaFuma:e(upmlO0,000BTID x $12.~0=$.v~.~~_ <br />Gas Furna~ (ov~ 100,000 BTU) '--~ x $15.00 -- $ ~1 <br />Gas Fu'~place / ~ $1iOO = $ ~ <br />Gas Water Heat~ I xx <br />Gas Log Lighter -- x $15.00 = $ -- <br />Ga~Barb~lU~ -- x $15.00--$__ <br /> <br />Gm Piping <br />Eacaoutl~upto4oud~ __~-- x $4.00=$ ~' ~' <br />Each additional outl~ over 4 oatlets -- x SL00 = $__ <br /> <br />$us~H~atar -- x $12.00=$__ <br />WallH~atc~ -- x $12.00=$__ <br />Pioo~MountedHeamr __ x $1Z00=$__ <br /> <br />Un~r 3 Ton __ x <br />3 Ton and Mote -- x $22.00=$__ <br /> <br />Und~r3Ton -- x $Ii00=$__ <br />3 Ton and More __ x $22.00=$__ <br />Evaporative Coolc~ -- x $9.~0 = $ -- <br /> <br />Coral Exhaust Sysmn __ x $9.00 = $__ <br />Coral Hac~ & Eahau~ __ x $9.00=$__ <br />Dom~tic Range Hood (includes duc~) __ x $9.00 = $ -- <br />Domestlc Exhaost Fans __ x $6.00=$__ <br />Dom~tic Dryer Vents __ x $6.~0 = $__ <br />Appliance Ve~tz installed and <br />not included in an apglianc~ pc~nit -- x $6.00=$__ <br /> <br />Woodstove 1 Flrepla~ __ x $15.00 = $ -- <br />Ftre Daraper __ x $6.00=$__ <br />Coral / Industrial Incin~ator x $60.00=$__ <br /> <br />Omtl'~oFam~l~-m.~_t~,:.~,amF~ __ x $ .04=$__ <br /> <br />Dv~fl~ Permit Lalnd, *%f~ __~$ <br />(For N~w Dwellings O,Jy) <br />Other (as required by the Buildiag Official) <br /> <br />TOTAL AMOUNT DUE <br /> <br /> <br />