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I <br />FOR CITY VALIDATION [ <br />Received by: <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> 285 Church St NE · Room 132 pIZRMFF NO: <br /> Salem, OR 97301 <br /> <br />24 Hr Inspection Line: 588-7904 <br />Office: 588-5147 8:00 a.m. - 4:30 p.m. <br />FAX: 588-7948 <br /> <br />Date: <br /> <br />Issued by: <br /> <br />MECHANICAL PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />~ 1. LOCATION OF INS'rALLATION <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 ONLY <br /> <br />Contractor <br /> <br />Phone <br /> <br />Mailing Address <br />Contractor's License No. <br />Contrnctor's Board Reg. No. Job No. <br />Contrnctor's Signature: <br /> <br />.~2B. FOR OWNRR INSTALLATIONS <br /> <br />r~ <br /> <br />4. FEE SCHEDULE (Complete and enter total in Al below) <br /> <br /> RESIDEHTIAL [~ COMMERCIAL [] <br /> USE OF STRUCTURE: <br /> NEW Q ALTERATION O ADDITION O RELOCATION <br /> <br />GAS ~ or ELECTRIC <br /> <br />BASE FEE <br /> <br />No. X <br /> <br />FORCED AIR FURNACE <br />up to 100,000 BTU $ 6.00 <br />over 100,000 BTU $ 7.00 <br /> <br />Floor Fumace $ 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 COHDITIONER <br />under 3 Ton $ 6.50 <br />3 Ton and up $11.00 <br /> <br />EvaporativeCooler <br />Commercial Exhaust System <br />Commercial Hood end Exhamt <br />Domestic Range Hood <br />Doznestic Exhaust Fans <br /> and D~er Vents <br />Fire Damper <br /> stov pl .. °e.i &-/-._. <br />Furnace Docts (AlterationfExtension) <br />Commercial / Industrial Incinerator <br /> <br />ADDITIONAL APPLIANCES <br /> Gas Water Heater <br /> Gas Log Lighter <br /> Gas Barbeque <br /> Other <br /> <br />GAS PIPING SYSTEM <br /> 1-4 outlets (per outlet) <br /> 4 and up outlets (per outlet) <br /> <br />Appliance Vents not included in <br />an applinnce permit <br /> <br />OTHER (as required by Builo~og Of~ciM) <br /> <br /># of Labols <br /> <br />DWELLING PERMIT LABEL <br /> <br />$4.50 <br />$4.50 <br />$4.50 <br />$4.50 <br /> <br />$ 3.00 <br />$ 3.00 <br />$ 7.~o <br />$7.50 <br />$~0.00 <br /> <br />$7.50 <br />$7.5O <br /> <br />$7.5O <br /> <br />$ ZOO ~ <br />$ 30 <br /> <br />$ 3.00 <br /> <br />N/C <br /> <br />3. PLANRBVIEW SECTION <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 />~ 15-41 <br />Rev. 12/~ <br /> <br />5. FEES <br /> Al. Enter total of fees from Sec. #4 <br /> A2. Add 5% surcharge (.05 x Al) <br /> Subtotal <br /> <br /> B. Enter 25% of line A 1 for Plan Review <br /> (Al + .25), if required <br /> C. Investigation Fee (if required) <br /> D. Reinspection Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br /> Receipt No. <br /> <br /> <br />