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FOR CFFt' USE ONLY <br />R.ecelved By. Date: <br />Zoning By:__ City:. <br /> <br />1. LOCATION OF fiNSTALLATION <br /> <br />MARION COUNTY BUILDING ~SPECTION <br />COMMUNITY DEVELOPMENT CENTER <br />3150 Lancaste~ Dr. NE- Suite C. Salemd Oregon 97305 <br />g.00 am-4.30 pm <br />24 1~. Inspechon Line 3734427 FAX 588-7948 <br /> <br />ParcclOvmec~' . /.~._ · - , . ~ , <br /> <br />2A. CONTRACI'OR INFORMATION -- PLEASE INDICATE WHO IS <br /> <br />PropeR3 Owner: ~lease pnnt~' <br /> <br />Mailing Address: <br /> <br />I am the PROPERTY OWNER and own. reside in. or wdl restde in the <br />completed structure and will be my own general contractor. [ understand <br />that I m u~t reg~ter as a cor~tr~ctton contractor cf the structure is sold or <br />offered for sale before or upon completion. IfI hire subcontractors. I will <br />hire only subcontractors registered wtth the Construction Contractors Board. <br />[fl change my m~nd and do hire a general contractor who is registered wtth <br />the Construction Contractors Board [ will tmmedtately noti~. Marion County <br />of the name of the contractor: <br /> <br />4. FEE SCHEDULE (complete and eater total in Al) <br /> <br />,SvSDENTIAL ( ) COMMERCIAL <br /> ADDITION <br /> RELOCATION ~) REPLACEMENT <br /> <br />Furnace (includes ducts / vents) <br />Forced ,Sar up to 100.000 BTU <br />Focced Air over 100.000 BTU <br /> <br />ALTERATION <br /> <br />G~ Fuma~ (up to 100.000 BTU) <br /> <br />Gas Log Light c~ <br />Gag Barbeque <br /> <br />$12.00 = $ <br />$15~0 =$ <br />$15.00 = $ <br />$15.00 = $ <br />$15.00 = $ <br />$15.00 = $ <br /> <br />Gas Piping <br />Each outlet u p to 4 o~tlets <br />Each additional outlet over 4 outlets <br /> <br />x S 400 =~ <br />x$ 1.00= <br /> <br />Suspended Heat~ <br />Wall Healer <br /> <br />x $12.00 = $ <br />x $ i2.00 = $ <br />x $12.00 = $ <br /> <br />Under 3 Ton <br />3 Ton a~d More <br /> <br />x $2200 = $ <br /> <br />Undex 3 Ton <br />3 Ton and More <br />Evapo~afiw Coole~ <br /> <br />x $15.00 <br />x $22.00 <br />x $ 9.00= $ <br /> <br />Exhaust / Fans I VeaLs <br />Coral Exlmust System <br />Coral Ho~d & Exhaus~ <br />Domestic Range Hood (includes ducts) <br /> <br />x $9.00 = $ <br />x $ 9.00 = $ <br />x $9.00= $ <br />x $600= $ <br />x $ 6.00 = $ <br /> <br />x $ 6.00 = $ <br /> <br />OneFI'~ FamRy Dwelling Fee Square Feet: x $ .04 = $ <br />l)wdllag Permit Labels # of Labels ~ $ N/C <br /> <br />5. FEES <br /> <br />C. Investigation Fee, if required <br /> <br />D. RemSpectwn F~ ($50.00) <br />E. Adda~onal ?hid Review. $62.50/hour, ( minimum one half hour{ $ <br />F. laspectio~ fc~ whw. h no fee is specifically indicated $62.50gar. <br /> <br />.. Seismm Fee(.Ol%x Al) <br /> <br /> <br />