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MAroON COUntrY ~.~ A <br /> r BUILDING INSPECTIO~ DIVISION PERMIT NO: / O U["~ <br />* IFOR CITY VALIDATION 315o Lancaster Dr. NF~- Suita C ' <br />IR¢¢¢ived By: __ Salem, Oregon 9775-~1398 Date:____ <br /> LD~~PPll~?~~Lpm Issued by: ____ <br /> <br />~o~ss I~0 <br /> <br />?RO?ERTY OWNER <br /> <br />DIRECTIONS <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT <br />STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK 1S SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONT~RACTOR INSTALLATION ONLY <br /> <br /> CONTRACTORS BOARD I,--, I.--d, ,It I1 I I I <br /> <br />2B. FOR OWNER INb~rA-~LATIONS <br /> <br /> Property Owner (please prinO <br /> <br /> Mailing Address <br /> <br /> City, State, Zip <br /> <br /> Owner's Signature <br /> <br /> ~gent'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 /> CAS ~ ELECTRIC [~ <br />~R~ACE O~V <br /> <br />FORCED AIR UP TO 100,000 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 x $6.00 <br /> <br />GAS LOG LIGHTER <br />GAS BARBEQLIE <br /> <br /> (For New Single Family Dwellings Only) <br /> <br />x $7.50 = $ <br />x $7.50 = $ <br /> <br />x $2.00 = $ <br />x $30 = $ <br /> <br /> $6.0t} <br /> $6.00 <br /> $6.00 <br /> <br />$6.50 <br />$1L00 <br /> <br />x $6.50 <br /> <br />x $4.50 <br /> <br />x $4.50 <br />x $4.50 <br />x $4.50 <br />x $3.00 <br />x $3.00 <br /> <br />x $3.00 <br /> <br /> x $7.50 <br /> x $3.00 <br />x $30.00 <br /> <br /># of Labels <br /> <br />5. FEES <br /> <br /> A2, Add 5% surcharge (,05 x Al) <br /> <br />B. Enter 25% of line A1 for Plan Review <br /> (Al + .25), if r~quired <br />C. lnveffigafion Fee (if r~quired) <br />D. Rein~pectinn Fee ($25.00) <br /> TOTAL AMOUNT DUE <br />Receipt No.__ <br /> <br />=$ <br />=$ <br />=$ <br /> <br /> $ <br /> <br />7O <br /> <br />=$ <br /> $ <br />=$ <br /> <br />=$ <br />=$ <br />=$ <br />=$ <br /> <br />~$ <br /> <br />=$ <br />=$ <br /> <br />N/C <br /> <br />$ <br /> <br />MC 15-41 7/97 <br /> <br /> <br />