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};OR CITY VALIDATION <br />Received by: <br />Date: I 24 Hr In~:ction Lia~ <br /> Office: 588~- 4:~0~[~. <br /> <br /> Plot~o ¢omplot, ~l ~tlon., I through 5 <br /> <br />MARION COUNTY <br />BUILDING INSPECTION DIVISION <br />3150 LANCASTER DR NE - SUITE C <br />SALEM OREGON 97305-1398 <br /> <br />MARION C <br /> <br />PEBM1T~ ARE NON-TRANSFERAELE AND EXPIF~ IF WORK IS NOT <br /> STAR'rJ~D WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPeNDeD FOR 180 DAYS. <br /> <br />CONTRACTOR ]N$I'ALLATION ONLY <br /> <br />2B. FOR O~ INSTALLATIONS <br />hopeay Owner (p/e~pri.'~) <br /> <br />Date: <br /> <br />Issued by: <br /> <br /> J E~2HEDULE (C~snplcte and enter total in A1 below) <br /> <br /> RBS1DBNTIAL J~ COMMERCIAL [] <br />}U~E OF STRUCTURE: <br /> <br />JJll~J~ ALTERATION 12 ADDIT/ON O RELOCATION O <br /> or ELECTRIC ~/. <br /> <br /> No. X Fe~ = Sum <br />BASE FEE $10.~0 <br /> <br />FORCED AIR FURNACE <br />up to 100,000 BTU $ 6.00 <br />over 100,000 BTU $ 7.00 <br /> <br />Floor Furnace $ 6.00 <br />~us pet~ed~e~t~r ............ $6~00 - <br />Wall Heater $ 6.00 <br />Floor Mounted Heater $ 6.00 <br /> <br /> 6.50 <br />Su.oo <br /> <br />$ 6.50 <br />$11,00 <br /> <br />HEAT PUMp <br /> under 3 Ton <br /> 3 Ton and up <br /> <br />AiR CONDITIONER <br /> uud~r 3 Ton <br /> 3 Ton and up <br /> <br />EvaporativeCoolcr <br /> <br />$ 4~:~ <br /> <br />$4.50 <br />$4.50 <br /> <br />$ 3.00 <br />$ 3.0O <br />$7.50 <br />$7.50 <br /> <br />Gas Log Lighter $ 7.50 <br />Gas Batbeque $ 7.50 <br />O~r $ 7.50 <br /> <br />NIC <br /> <br />Mailing Addreaa { Phone <br /> <br />City/State/Zip <br /> <br />Owner's Signature: <br /> <br />Agent's Signamm: <br /> <br />GAS PIPINO SYSTEM <br /> 14 outlets (per outlet) <br /> 4 and up outlets (per ~mtlet) <br /> <br />OTHER (as required by Bullet <br /> <br />$ 2.00 <br />$ .50 <br /> <br />$ 3.00 <br /> <br /> 3. PLAN RBVIEW SBCTION <br />IMadon County doe~ not require a plan review. <br /> We will provide plan review sorvice if you complete <br /> Section 5B and submit two (2) sets of plans and <br /> specifications with this application. <br /> <br />5. FRBS <br />Al, Enter total of fees from S~C. <br />A2, Add 5% s~ (.05 x Al) $~ <br /> ~bt~l $.~ <br /> <br /> B. ~ter25~ ofl~eAI forP~ ~view <br /> (Al + ~, if~ <br /> C. hv~t~n~n F~ (if~) $.~ <br /> D. Rc~tion F~ ($~.~) $ <br /> <br /> ror <br /> R~ipt No. <br /> <br /> <br />