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..................................... ~ [ [ i {) ~ O) UNT¥ {{uILDIN~ {NSI'ECtION <br /> <br /> Received By: Ds,e: 31 ~0 '-nc,,ter ~. NE- ~e C, ~'~, ~on 97305 <br /> <br />{~ec¢ipt #: .............. Amounts <br /> <br />I. I.OCATION OF INSTALLATION <br /> <br /> OCT 2 <br />hi 'i d C011 <br /> : INS <br /> <br /> PERMITYYARENON-TRAN~FER/IBLEANDEXPIREIFWORK ] <br /> IX NOT XFARTED 9TTIIIN I ~ DA ~ OF I,VSUANCE OR IF <br /> WORK I.~ RU~PK~ED FOR I~0 DAI~. " <br /> <br />2A. (X)NT~OR INFO~TION ~ PLEASE INDICATE WIIO IS <br />I~ING TIlE WO~ <br /> <br />c..,.dor: Loren's Heatina & Sheet MeLal. Inr <br />M.iH.BAd&e.. 2355 Hyacinth NE <br /> <br />Salem mate: OR zip: 97303 <br /> <br /> 503-370-7640 <br /> <br /> I <br />503-370-9879 ] <br /> <br /> 7594 / <br /> <br />Property Owner: (~lease print) <br /> <br />klnilin{{ Address: <br /> <br />I nm the PROI'KRTT OIIgVF~ and ow~t eeslde in, or will reside <br /> <br />o~red for .~ale before or upo, completion If! hi~e ~t~contrac~or.% I will <br /> <br />3, PI,AN REVIEW SECTION <br />} specifications wilh Iht! application, <br /> <br />~RESIDENTI^L ( )COMMERCIAL ( )OAS ~JU{I,ECII;~IC <br /> <br />Ile,dcr~ <br />8uspended tleater <br />Waft lleater <br />Flout Mounted Ileater <br /> <br />Ileal I~mp <br />Un des' 3 Ton <br />~{ Ton and k(ore <br /> <br />~lr Conditioner <br />Under 3 Ton <br />3 Ton and More <br />Evaporative Cooler <br /> <br />Weodstove ! Firepiace <br />Fire Dian{er <br />Coml / Indus~al Incinerator <br /> <br /> .... x $12.00 ~ $_ <br /> .... x $15.00 ~ $ <br /> ._ _ x $1200 ~ <br /> .... x $15.O0 ~ $ <br /> <br /> .... x $1~00 = $ ..... <br /> .... ~ $15.00- $ .... <br /> ..... x $1~.00- {; ..... <br /> <br />.... <br /> <br />_ __ x Sf2.00 ~ $ ..... <br />...... x $12.00 ~ $__ <br />...... x $12.00 ~ $ ..... <br /> <br />..... x $12.00 ~ $ <br />/ x $22,00 = <br /> <br />.... x S22.00 = $ <br /> <br />___ <br />____ x $9.00- $ .... <br />..... x $9.00= $ <br />____ x $600 = $ ..... <br /> x $ 6.00- $ <br /> <br />...... x $6.00= $ .... <br /> <br />----_ x $15.00 ~ $__ . <br />..... <br /> <br />l)wellln{~ PermlI Labels ~t of l.~b¢lm ..... ('~ S <br />(For New ~elling~ (~ly) <br />~et (~ reqnired by ~e Buildi. g Official} <br /> <br />S. PEES <br />At. RAXE FEE ASsesred on ALL /IPPL/¢,'A TION.% <br />A2. EnterTo(al Fees from ~ection <br /> <br />B. ~iez 30% or l}.u A{ For Hah <br />C. Investigation Fee. ir teq.i,ed <br />D. ~einspection Fee (S50.~) <br /> <br />E. Addltlo.sl Plan Review. $62150/11o11£, ( n~illilnll}{1 (1He hnlrho.r] $ <br /> <br />F. Inspection for which no Fee is ~pecil]cally indicated, $62 50d*r. <br /> (mt.imam one Imm) <br />O, Inspection Outside Normal <br /> (minimum two ho..) <br /> <br /> <br />