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FO~R CITY USE ONLY <br />Received By: Date: <br />Zoning By: City: <br /> <br />Ptease complete aB Sextons, I through $ -- [ i - <br /> <br /> ~q~&RION COUNTY BUILDING INSFECq'ION RECE~/ED <br /> COMMUNIIT DEVELOPMENT CENTER <br />3150 ~nc~ter ~. NE - Suite C, Salem, ~egon 97305 <br />g:00~-4:30pm JUL 01 1999 <br /> 24 hr. Inspection Line 373-4427 F&X 588-7948 <br /> MARION COUN <br /> / / ' ~ RH INR I~RPgRTIn~ <br /> <br />1. LOCATION OF INSTALLATION <br /> <br /> Site Address: ' <br /> <br /> Zip: <br /> <br />Pho.e: 0-V )Z to (au <br /> <br /> Projecl Description: <br /> <br /> PERMITS ARE NON-TRANXFERABLE AND EXPIRE iF WORK <br /> I$ NOT XTARTED WITHIN 180 DA YS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DA IT. ,' <br /> <br />2A. CONTRACTOR INFORMATION -- PLEASE INDICATE WllO IS <br />DOING THE WORK <br /> <br /> Contractor: <br /> <br />Property Owner. (p/ease print) <br />Mailing Address: <br />City: Slate: Zip: <br />Phone: Fax: <br /> <br />I am the PROPERTY OIfTqER ami own, reside in, or will reside in the <br />completed str~cture attd will be m), own general contractor. I understand <br />that ! must register as a constr~ction cotttractor if the structure is gem or <br />offered for sale before or upon completion_ [fi hire subcontractors, I will <br />hire only subcontractors registered with the Construction Contractors Board <br />lfl change my mind attd do hire a getterat contractor who is registered with <br />the Cottstructlon Contractors Board. I will immediately irotiJj, MaHon CounO, <br />ofthe 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 review <br />service if you complete Section 5B and snbmit two (2) sets of plans and <br />speeillcat OhS w th th s appl cat on. <br /> <br />~RESIDENTIAL ( )COMMERCIAL <br />( )NEW O~ ADDITION <br />( ) RELOCATION ( ) REPLACEMENT <br /> <br />Furnace (includes ducts t venLs) <br />Forced Air up to 100,000 BTU <br />Forced Air over 100,000 BTU <br />lqoor Furnace <br />Duc~. (Alterations/Extension) <br /> <br />MC L54 1 Rev 9,98 <br /> <br />( ) GAS (~ELEC]RIC <br />( ) ALTERATION <br /> <br />OTy <br /> <br />Gas Installation <br />Gas Furnace (up to 100,000 BTU) <br />Gas Furnace (over 100,000 BTU) <br />Gas Fi~plaee / Inse~ <br />G~s Water Heater <br />Gas Log Lighter <br /> <br />Heat Puree <br />Under 3 Ton <br />3 Ton and More <br /> <br />$12.00 <br />$15.00 <br />$12.00 <br />$15.00 <br /> <br />Air Condi6oner <br />Under 3 Ton <br />3 Ton and More <br />Evaporative Cooler <br /> <br /> $12.00 = $ <br />x $15.00 = $ <br />x $15.00 = $ <br />x $15.00 = $ <br />x $15.00 = $ <br />x $15.00 = $ <br /> <br /> $ 4.00 = $ <br />x$ 1.00 = $ <br /> <br /> $i2.00- $ <br /> $12.00 = $ <br /> <br />Exhaust 1 Fans / Vents <br />Coral Exhaust System <br />Coml Hood & Exhaust <br />Domesti~ Range Hood (includes ducts) <br />Domestic Exhaust Fans <br />Domes'tie Dryer Vents <br />Appliance Vents installed and <br />not included in an appliance permit <br /> <br />$12.00 <br />$22.00 <br /> <br />x $15.00 = $ <br />x $22.00 = $ <br />x $ 9.00 = $ <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 />Additional A Dnliancez <br />Wondslove/Fireplaee __ x $15.00- $ <br />Fire Damper x $ 6.00 = $ <br />Coml/induslriallneinerator x $60.00 = $ <br /> <br />5. FEES <br />Al. BASE FEE Assessed on ALL AI'I'LI CA TIONS: <br />A2. l'~terTotal Fees from Section #4 <br /> SUBTOTAL <br />A3 Add State Surcharge (.05% x Al +A2) <br /> <br />B. Enter .30% of line Al for Plan Review <br />C. Investigation Fee, iFrequired <br />D. Reinspection Fee ($50.00) <br />E. Additional Plan Review, $62.50/hour, ( minimum one half hour) <br />F. Inspection for which no lee is specifically indicated, $62.50/hr, <br /> (mininmm one hour) <br />G. Inspection Outside Nonual Business llours, $62.50/hr. <br /> (minimum two hours) <br />H. Seismic Fee (.0 I% x At) <br /> <br /> $ <br /> $ <br /> <br /> $ <br /> <br />$ <br />$ <br /> <br /> <br />