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FOR OFFICE USE ONLY <br />Rc~:eived by: __ <br />Date: .... <br /> <br />MARION COUNTY BUiLDING INSPECTION <br /> <br />220 ~ SU~et NE <br />Salem, Oregon 97301 <br /> <br />Phouo $$8-$I47 S~OO~m.~ 4:30 <br /> Code-A-Phone: 598-7904 <br /> FAX: <br /> <br />MECHANICAL PERMIT APPLICATION <br /> <br />Please complete all Sections, I through 5 <br /> <br />SITE #: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />Pormlt No. <br /> <br />LOCATION OF INSTALLATION <br /> <br />PERMITS ARE NON-TRANSFERABLE AND NON.PoEPUNDABLE AND <br />I~XFIRE IF WORK IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE <br />OR IF WORK IS SUSpI~NDED FOR 150 DAYS, <br /> <br />2A. CONTRACTOR iNSTALLATION ONLY <br /> <br />~. FOR OWNER INhALaTiONS <br /> <br />Property Owacr <br /> <br />Mailing Addres~ Phone <br /> <br />CitytSta~/Zip <br /> <br />'thc installation is being nude on pmpcliy I own which is not intended for s~le, <br /> <br />PLAN R~VIEW SECTION <br /> <br />We will provide plan review service if you complete Section <br />5B and submit two (2) sets of plans and specifications with <br />this application. <br /> <br />This optional plan review program does not suspend the <br />requked submission of plans, and Specifications when required <br />by the Oregon S~uctural Specialty Code, Chapter 53. <br /> <br />Rev. 5/93 <br /> <br />4. FF~ ~CREDULE (Con~k~ ~1.0~ ~l h Al ~tow) <br /> <br /> [] [] <br /> <br />Forced Air Furnace <br />100,000 BTU or less <br />Ov~ 100,000 BTU <br /> <br />Floor Furnace <br />Suspen~d Heater <br />Wall Heater <br />Floor Mounted Unit <br /> <br />Heat Pump [] / Air Conditioner [] <br /> Up to 3 Ton <br /> 3 Tou to 1 $ Ton <br />Evaporative Cooler <br />Exhaust System, Commereiel <br />Hood and Exhaust, Comm~ial <br /> <br />Domestic Range Hood <br />Domestic ~ust Fans <br /> and Dryer V~ts <br />Fire Da~per <br />Wood Stove <br />Furnace Ducts (Alteration, Ext~msion) __ <br /> <br />Commercial or Industrial Incinerator <br /> <br />Gas Water Heater (relocation <br /> or replacement) <br />Gas Counectioa <br /> --l~r outlet, up to 4 <br /> --over 4, $8.00 plus <br /> additional <br /> <br />For the I~tallation, Relocation <br /> or R~olaccment orca. Appliance <br /> Veto not included in an <br /> Appliance permit, <br /> <br />Other (as r~luired by Building Official) <br /> <br />5. ]FEES <br /> <br /> Su~otnl <br /> <br /> ~). lnv~-'tigafion F~ (if mt.~:sl) <br /> . R,~in~t~tic~ F~ ¢25 J00) <br /> <br /> $10.00 <br /> <br />6.00 <br /> <br />7.~0 <br /> <br />6,00 <br />6.00 <br />6,00 <br />6,00 <br /> <br />__ $ 6.00 <br />__ $11.00 __ <br />-- $ 4.50 <br />__ $ 4,50 <br />__ $ 4,50 <br /> <br />__ $ 4.50 <br /> <br />__ $ 3.00 <br />__ $ 3,00 <br />__ $ 7.50 <br /> $4,50 <br /> <br />__ $30,00 <br /> <br />__ $ 7.50 <br /> $ zoo fi, OD <br /> <br />__ $ .$0 <br /> <br />__ $ 3,00 <br /> <br /> <br />