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FOR CITY VALIDATION] <br />Received by: [ <br />Date: ] <br /> <br />COMMUNITY I~EYELOPMENT CENTER ~.~/~ ~.~ <br /> 285 Church St NE. R~m 132 ~. N~: ,., ,~ <br /> S~em, OR97301 ~ ~,1 - ~ ~0:~';;~ <br /> <br /> ~ Hr ln~t~n L~o: 58~7~ MARION COUNTY <br /> Off~ 58~5147 8:~..m.-4:30p.m. [SSU~l~~ ~p~i~T~fi~'~ <br /> F~: 588-7948 <br /> <br /> MECHANICAL PERMIT APPLICATION <br /> Please complete all Sections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />D~cription/Ddi~ctious <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT <br /> STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION OHLY <br /> <br />Contractor's License No. <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br />Property Owner (p]ea~eprlt~) <br /> <br />Mailing Address I Phone <br /> <br />City/State/Zip <br /> <br />Owner's Signature: <br /> <br />Agent's Signature: <br /> <br />3. PLANRBVIBW SBCTION <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 />MC 15-41 <br />Rev. 12/94 <br /> <br />4. FEE SCHEDULE (Complete and enter total in Al below) <br /> RESIDENTIAL~ COMMERCIAL [~ <br /> USE OF STRUCTUREZ <br /> ./ <br /> NEW ~ ALTERATION ~ ADD1TION~OCATION ~ <br /> GAS ~ or ELECTRIC U <br /> No. X Feo = Sum <br />BASE FEE $10.00 <br /> <br />FORCED AIR FURNACE <br />up to 100,000 BTU $ 6.00 <br />over 100,000 BTU $ 7.00 <br /> <br />Floor Furnace $ 6.00 <br />Suspended Heater $ 6.00 <br />Wall Heater $ 6.00 <br />Floor Mounted Heater $ 6.00 <br /> <br />HEAT PUMP <br />under 3 Ton $ 6.50 <br />3 Ton and up $11.00 <br /> <br />AIR CONDITIONER <br />under 3 Ton $ 6.50 <br />3 Ton and up $11.00 <br /> <br />EvapomtiveCooler $ 4.50 <br />Commercial Exhaust System $ 4.50 <br />Commercial Hood and Exhaust $ 4.50 <br />Domestic Range Hood $ 4.50 <br />Domestic Exhaust Fans <br />and Dryer Vents ~. $ 3.00 <br />Firo Damper ~ $ 3.00 <br />Wood StovdFir~place ,.~,' e/4 ~ r~d~-4~ ~'~ $7.50 <br />Furnace Ducts (Alteration/Extension) $ 7.50 <br />Commercial / Industrial Incinerator $30.00 <br /> <br />ADDITIONAL APPLIANCES <br />Gas Water Heater $ 7.50 <br />Gn~ Log Lighter $ 7.50 <br />Gas Bnrbeque $ 7.50 <br />O~her $ 7.50 <br /> <br />GAS PIPING SYSTEM <br />1-4 outlets (peroutle0 $ 2.00 <br />4 and up outlets (per outlet) $ .50 <br /> <br />Appliance Vents not included in <br />an appliance permit $ 3.00 <br /> <br />OTHER Os required by Buil&'qg Ol~ciaD <br /> <br />DWELLING PERMIT LABEL # of Labels <br /> <br />N/C <br /> <br />5. FBE5 <br /> Al. Enter total of fees from S~c. fi4 <br /> A2. Add 5% surcharge (.05 x Al) <br /> Subtotal <br /> <br /> B. Enter25% of lineAl for Plan Review <br /> (Al + .25), if r~quired <br /> C. Investigation Pee (if required) <br /> D. Rein~pection Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br /> Receipt No. <br /> <br /> <br />