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FOR CITY USE ONLY <br />Received By:. J Date: <br />Zoning By: City:. <br /> <br />ProjeetDes~ption: /~ppl~/q OM <br /> <br />15 NOTgTARTED WITIIIN 180 DAYS OFI$~UANCE OR IF <br />WORK IS SUSPENDED FOR 180 DA YS~ <br /> <br />2A. CONTRACTOR INFORMATION -- PLEASE INDICATE WHO IS <br />DO lNG THE WORK <br /> <br />Zip: <br /> <br />Registration Number: ~/.._0 L./0 ~ <br /> <br />Property Owner: (please prim) <br /> <br />Mailing Address: <br />City: State: Zip: <br />Phone: Fax: <br /> <br />t am the PROPERTY 0 WNER and own, reside in, or will reside in the <br />completed structure and will be my own general contractor. I understand <br />that I must register as a construction contractor if the structure is sold or <br />offered for sale before or upon completion, lfl hire subcontractors, I witl <br />hire only subcontractors registered ~vith the Construction Conlractor$ Board. <br />Ill change my mind and do hire a general contractor who is registered with <br />the Construction Contractors Board, I will immed~ately notify Marion County <br />of the name of the contractor: <br /> <br />Owner's Signature: <br />Agent's Signature: <br /> <br />PLAN REVIEW SECTION <br /> <br />Marion County does not require a plan review. We will provide plan review <br />service if you complete Section 5B and submit Ix~ (2) sets of plans and <br />spec ficatinns with this application. <br /> <br />4. FEE SCHEDULE (complete and enter total in Al) <br /> <br />MARION COUNTY BUILDING INSPECTION <br />COMMUNITY DEVELOPMENT CENTER <br />3150 Lancaster Dr. NE - Suite C, Salem, Oregon 97305 <br />8:00 am- 4:30 pm <br />24 hr. Inspection Line 373-4427 FAX 588-7948 <br /> <br />( ) NEW <br />( ) RELOCATION <br /> <br />( ) COMMERCIAL <br />(~) ADDITION <br /> REPLACEMENT <br /> <br />( ) GAS ( ) ELECTRIC <br />( ) ALTERATION <br /> <br />QTY <br /> <br /> Furnace (includes duct~ / vents) <br />Forced Air up to 100,000 BTU <br />Forced Ah' over 100,000 BTU <br />Floor Furnace <br />Ducts (Abmations~xtension) <br /> <br />Gas Installation <br />Gas Furnace (up to 100,000 BTU) <br />Gas Furnace (over 100,000 BTU) <br />Gas Fireplace / lnse~ <br />Gas Wet~r Heater <br />Gas Lng Lighten' <br />Gas Barbeque <br /> <br />Gas Piping <br />Each outlet up to 4 outlets <br />Each additional outlet over 4 outlets <br /> <br />$12200 = $ <br />$15.00 = $ <br />$12.00 = $ <br />$15.00 = $ <br /> <br />x $12.00 = <br /> x $15.00 <br /> x $15.00 <br /> x $15.00 <br /> x $15.00 <br /> x $15.00 <br /> <br />x $ 4.00 = $ <br />x $ 1.00 = $ <br /> <br />Suspended Heater <br />Wall Heater <br />Floor Mounted Heater <br /> <br />x $12.00 = $ <br />x $12.00 = $ <br />x $12.00 = $ <br /> <br />Heat Pumo <br />Under 3 Ton <br />3 Ton and More <br /> <br />x $12.00 = $ <br />x $22.00 = $ <br /> <br /> Air Conditioner <br /> Under 3 Ton <br />' 3 Ton and More <br /> Evaporative Cooler <br /> <br /> Exhaust / Fans / Vents <br /> Coral Exhaust System <br /> Coral Hood & Exhaust <br /> Domestic Ranga Hood (includes ducts) <br /> <br /> Appliance Vents installed and <br /> <br />x $15.00 <br />x $22.00 <br />x $ 9,00 <br /> <br />x $ 9.00 <br />x $ 9.00 <br />x $ 9.00 = <br />x $ 6,00 <br />x $ 6.00 <br /> <br />x $ 6.00 = <br /> <br />x $15.00 = <br />x $ 6.00 = <br />x $60.00- <br /> <br />Onefl'woFamilyDv~lling Fee Square Feet: __ x $ .04 = $ <br />D~elling Permit Labels # of Labels __ ~ $ N/C <br />(For New Dwellings Only) <br />Other (as required by the Building Official) $ <br /> <br />FEES <br />BASE FEE Assessed on ALL APPLICATIONS: <br />Al. EnterTotal Fees from Sectinn #4 $ <br />A2 Add State Surcharge (.05% x Al) $ <br /> SUBTOTAL: <br />B. Entsa'.30%oflineA1 for PianReview <br />C. Investigation Foe, if requital <br />D. Remspoction Fee ($50.00) <br />E. Additional Plan Review, $62.50/hour, ( minimum one belfhour) $ ___ <br />F. Insl~etinn for which no fee is specifically indicated. $62.50/hr, <br /> (minimum one hour) $ __ <br />G. Inspection Outside Normal Business Hours, $62.50/hr, <br /> (minimum two hours) $ <br />H Seismic Fee (.01% x Al) $__ <br /> TOTAL AMOUNT DUE $ <br />MC 15-41 Rev 9/98 <br /> <br /> <br />