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cc- <br />[ .................................... ] g""%l--"F~l'" I% #I..Mlk~ION COUNTY BUILDING INSPECTION <br />: o. v :l'flrA. J- I VIZI MMumrY oEv omE r <br />', Received By: Date: - ~ ' '~ ~caster Dr. NE - Suite C, Salem, Oregon 97305 <br />Zoning By City ' ~ ) 8'00am - 4'30pm <br />:Receipt~, Amount:$ i~/.~[jL ~ ~ ~ HR Inspect~on Line 373-4427 FAX 588-7948 /,7 <br /> <br /> .............................. .MARION COUNT~ <br /> ~m~¢~ PE~nrr APPUCAT[ON BI~ILDING INSPECTI <br /> P~e complete aH Sec~, I though 5 ] <br /> ~CA~ON OF ~STALLATION <br /> ~el ~: <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORE <br />lS NOT STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br />WORE IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INFORMATION -- PLEASE INDICATE <br />WHO IS DOING THE WORK <br /> <br />Mailing Address: <br /> <br />City: State: Zip: <br /> <br />Contractors Board <br />Registration No.: <br /> <br />Contractor's Signature: <br /> <br />2B. FOR OWNER INSTALLATION <br /> <br />I am the PROP~ OWNER a~ ow~ ~zide i~ or will ~ide in <br /> <br />st~c~m is soM or offend for *ale ~fo~ or u~n comp~t~n. Ill <br />Nm ~ubco~tor& I will Nre only z~contra~om ~giste~d with <br /> <br />Contracto~ B~ I will i~d~tely ~t~ Mar~n Co~ of t~ <br />PLAN ~W S~ION <br /> <br /> County does not require a plan review. We will provide plan I <br /> Marion <br /> review service if you complete Section 5B and submit two (2) sets of <br /> plans and spec fications w th this app cation. <br /> <br />MC 1541 Rev 9/98 <br /> <br />FEE SCHEDULE (complete and enter total in Al) <br /> <br />I~R~llNTIAL ( ) COMMERCIAL <br />( ) NEW ( ) ADDmON <br />( ) RELOCATION ( ) REPLACEMENT <br /> <br /> Fnmaee (includes ducts / vents) <br /> Forced Air up to 100,000 BTU <br /> Forced Air over 100,000 BTU <br /> Floor Furnace <br /> Ducts (AlterationsfExtensinn) <br /> <br /> Gas Fttmace (up to 100.000 BTU) <br /> Gas Furnace (over 100,000 BTU) <br /> Gas Fh~place / Insert <br /> Oas Water H~etet <br /> Oas Log Lighter <br /> Gas Barbeque <br /> <br /> cas eiping <br /> Each outlet up to 4 outlets <br /> Each additional outlet over 4 outlets <br /> <br /> Heaters <br /> Suspended Heater <br /> Wall Heater <br /> Floor Mounted Heater <br /> <br /> Under 3 Ton <br /> <br /> Domestic Dryer Vents <br /> <br /> (For New DwelLings Only) <br /> <br />( ) GAS ( )llLECTPdC <br />( ) ALTERATION <br /> <br />-- x $12.00=$ <br />-- x $15.00=$__ <br />-- x $12.00=$__ <br />-- x $15.00=$ <br /> <br />$12.00 = $ __ <br />$15.00 = $ __ <br />$15.00 = $ -- <br />$15.00 = $__ <br />$15.00=$__ <br />$15.00 = $ -- <br /> <br />-- x $4.00 = $__ <br />-- x $1.00=$__ <br /> <br />-- x $12.00=$__ <br />__ x $12.00=$__ <br />__ x $12.00=$__ <br /> <br />-- x $12.00=$__ <br />-- x $22.00=$__ <br /> <br />-- x $15.00=$__ <br />-- x $22.00=$__ <br />-- x $9.00=$__ <br /> <br />-- x $9,00 = $__ <br />-- x $9.00 = $__ <br />-- x $9.00 = $__ <br />-- x $6,00 = $__ <br />-- x $6.00 = $__ <br /> <br />-- x $6.00 = $__ <br /> <br />-- x $60.00=$__ <br />x $ .04=$__ <br /> <br /> ~of Labels __@ $ <br /> <br />BASE FEE Assessed on ALL APPLICATIONS: Al. Enter total of fees from See. ~4 <br /> A2. Add State Surcharge ~,~ x Al + Base Fee) <br /> <br /> B. Enter 30% of ~ Al f~ Plan Review <br /> C. Investigation Fee (if required) <br /> D. Reinspection Fee ($50.00) <br /> E. Additional Plan Review ($62,50/ht, <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 Ouff~de Normal Business Hours, <br /> ($62,50/hr, minimum two hours) <br /> H. Seismic Fee (.01% x Al)) <br /> <br />TOTAL AMOUNT DUE <br /> <br /> <br />