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Mig~CAL PERMIT APPLICATION <br />Pleate co~l~e all S~o~, I through 5 <br /> <br />1. LOCATION OF ~STALLATION <br /> <br /> parcel ID: <br /> Sil~Addl~ss: 10564 Mill Creek Rd. S.E. <br /> <br /> civf: Aumsville ~{p: 97325 <br /> <br /> ~lOw~r Donald & Jean Nelson <br /> <br /> ~: 749-2480 <br /> <br /> Cm~$u~Dk~cfiom: Hwy 22 south to Aumsvil] <br /> Exit. Turn lett-go to Mil± Greek xa. <br /> turn left. <br /> In'o}e~escnption: Replace gas furnace <br /> <br />]P~I~41TS NON-~W~LI~FEi~4~L~ AND IL~PIIt~ IF WO~ <br /> 1S N~ ST~ ~IN 1~ DA~ OF I~U~CE OR IF <br /> WO~ IS ~USPE~ ~OR 1~ DA~. <br /> <br />~ CO~R ~ON -- ~ ~1~ <br />~O ~ ~G ~ WO~ <br /> ~ Judson'a Inc. <br /> ~m~: P.O. Box 12669 <br /> <br /> ~: Salem s~: 0R ~: 97309 <br /> <br /> 503-363-~141 <br /> <br /> 503-399-8760 <br /> <br /> C~ ~ <br /> ~ N~.: 3460~ <br /> <br /> ~ ~R O~ ~ON <br /> <br /> Ci~: S~: ~P: <br /> <br />I am the PROPERTY OWNER and own, reside in, or will reside in <br />the coawlettd ~tructure and will he my own general contractor. 1 <br /> <br />structu~ Lv ~old or o~ered for ~le before or upon cornpletior~ Ill <br /> <br />Contractor~ Boatrl, I will immediately hotly Matron Cottony of the <br /> <br />Owner's <br /> <br />Agent's Siguaiu~: <br /> <br />3. PLAN REVIEW SECTION <br /> <br /> Marion Comgy does not requke a plan review. We will pto~dde plan I <br /> review s~rvice if you complem Section 5B and submi~ two (2) sets of <br /> p aris and sp~c ficatio~ w,ith this app icat on. <br /> <br />MC l~-41Rov9,~8 s.o. 303005 <br /> <br />MARION COUNTY BUILDING INSPF..CTION <br />COMMUNITY DEVELOPMENT CI~T{:i~. <br />3150 ~ Dr. l'4E, - Suit,,, C, Salem. Oregon 97305 <br />8:00am - 4:30pm <br />24 HR Insgn~ion ~ 373-4427 FAX 588-79~8 <br /> <br />C~ gE.SlDENTIAL ( )COMMERCIAL <br />[ ) N~W ( ) AoDmoN <br />) REL(X3Am~ON ( -A~IU~A~ <br /> <br /> OTY <br /> Emmlasa (indudas d,,et~ / wins) <br /> Fe~:~i Air up to l00,0gO BTU -- x $12.00=$__ <br /> Foe~d Air over l00,00O BTU -- x $15.00=$__ <br /> F]o~Fumace ~ x $12.00=$~ <br /> Ducts (Alt~atio~/~tte~on) ~ x $15.00 = S__ <br /> <br /> ,,zoo = s/.2? <br /> Oa~ Fumac~ (u~ m 100,000 BTU} <br />O~Fum~(ov,~lOO,OOOBTU} ~ x $15.00=$ <br />OmF~plaee/Insen ~ x $15.00=$ <br />OasW~t~lteaa~ ~ x $15,00~S~ <br />Gas LoS Ligtm- ~ x $15.00 = S ~ <br />GmBnrbeque ~ x $15.00=$__ <br /> <br /> Gas Piping <br /> Each omle~ up to 4 outlets ~ x $4.00=$__ <br /> Each additional outlet over 4 out[~a __ x $1.00 = $__ <br /> <br /> Su~Heatcr ~ x 512.00=.$__ <br /> WnHHoalar ~ x $12.00=$~ <br /> Fle~MoantadHeater -- x $12.00--$__ <br /> <br /> Undm3Ton __ x $12..00=$~ <br /> 3 Tontaad IVlm'o ~ x <br /> <br /> Undat 3 T~ ~ x <br /> 3T~naadM~e ~ x $22.00=$~ <br /> Ev~,~ --':ye Cool~ ~ x $9.00=5__ <br /> <br /> C. oud Exhaust Sysmu x <br /> Coral Hood & Exhau~ ~ x $9.00=$__ <br /> Domes~ gange I~od (in,fades ducta) ~ x $9.00 = $ ~ <br /> Dume~ia .Cxhaust Fans __ x $6.00=5__ <br /> Dumm~ic Dryer veats ~ x <br /> <br /> no~ imlt, d~ in m at~aian~ tmmit x $6.00 = 5 ~ <br /> <br /> Coml/Induva~al~:ima'~a' __ x $60.00=$ <br /> Or, e~eoFamllyD~ll~t~Fee:SquareFeec __ x $ .04=$~ <br /> Dwdllng Perl~t Laheia ~of Labels ~ $ N/C <br /> For New Dwetlinp Only) <br /> Obhet (as required by ~he Building O ff~ial) $ __ <br /> <br />TOTAL AMOUNT DUE <br /> <br /> <br />