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BUILDING INSPECTION DIVISION PERMIT <br /> FOR CITY VALIDATION 315o Lancaster Dr. NE- Suite C <br /> .... Salem, Oregon 97305-1398 ~ <br /> <br />Date: __ __ 24 HR Inspection ~ ne 373-4427 <br />I __ ~[ Office: phoni~ g:00am - 4:30pm Issued by: <br /> <br />1. LOCATION OF INSTALLATION <br /> T ACCO C NO-I ] I ]] <br /> <br /> D~C~ONS ~ ~ ~ ~ <br /> <br /> P~S ~ NON-~S~B~ ~ EXP~ IF WO~ IS NOT <br /> ST~ W~ 180 DAYS OF ISSU~CE OR <br /> WORK IS SUSPE~ED FOR 1~ DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />2B. FOR OWNER INST~ LLATIONS <br /> <br /> Property Owner ~vlease print) <br /> <br /> Agent's Signature <br /> <br />3. PLAN REVIEW SECTION <br /> <br />Marion County does not require a plan review. <br />We will provide plan review service if you complete <br />Section 5B and submit two (2) sets of plans and <br />specifications with this application. <br /> <br />~FEE ASSESSED ON ALL APPLICATIONS $10,00 <br /> <br /> FURNACE OTY <br /> FORCED AIR UP TO lCO,~00 BTU x $6.00 =$ __ <br /> FORCED AIR OVER 100,000 BTU x $7.00 = $ __ <br /> FLOOR FURNACE x $6.00 = $ __ <br /> DUCTS (ALTERATION/EXTENSION) x $7.50 = $ __ <br /> <br /> GAS FURNACE (up to I~,~00BTU) x $6.00 =$ <br /> GAS FURNACE (over t00,000 BTU) x $7.~0 = $ __ <br /> GAS FIREPLACE/INSER~ x $7.50 = $ <br /> GAS WATER HEATER x $7,50 = $ <br /> GAS LOG LIGHTER x $7.50 = $ <br /> GAS BARBEQUE x $7.5(I = $ __ <br /> <br /> GAS PIPING <br /> Each outlet up to 4 outlets x $2.~0 = $ ~t~O <br /> Each additional outlet over 4 outlets x $.50 = $ __ <br /> <br /> SUSPENDED HEATER x $6.{~ = $ -- <br /> WALL HEATER x $6.00 = $ -- <br /> FLOORMOUNTED x $6.00 --$ -- <br /> HEAT PUMP <br /> UNDER 3 TON x $6.50 = $ __ <br /> 3 TON AND MORE x $1L00 $ <br /> AIR CONDITIONER <br /> UNDER 3 TON x $6.50 = $ __ <br /> 3 TON AND MORE x $1L00 $ <br /> EVAFORATIYE COOLER x $4.50 = $ <br /> <br /> COML. EXHAUST SYSTEM x $4.50 = $ __ <br /> COML. HOOD & EXHAUST x $4.50 -- $ <br /> DOMESTIC RANGE HOOD x $4.50 = $ __ <br /> DOMESTIC EXHAUST FANS x $3.00 = $ __ <br /> DOMESTIC DRYER VE3gTS x $3.00 = $ __ <br /> <br /> ~'~rOODS'TO~E/FIRF~LACE li~'5~'~ '~ ~/~8~'/"~ x $7.50 =$ 7'~"0 <br /> <br />5. FEES <br />Al. Enter total of fees from Sec. 04 $ .~,t,t,t,t,t,t,t,t,~ ~ <br />A2. Add 5% surcharge (.05 x Al) $ <br /> SubtoIal $ <br /> B. Enter 25% of llne A 1 for Plan Review <br /> (Al + .25), ff requirad $ ~ <br /> C. Investigation Fee (if requffed) $ ~ <br /> D. Reinspecfion Fee ($25.00) $ ~ <br /> TOTAL AMOUNT DUE $ - . <br /> <br />Receip~ NO. <br /> <br />MC 1541 7/97 <br /> <br /> <br />