Laserfiche WebLink
FOR CITY VALIDATION <br />R~eivexl by: <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br />COMMUNITY DEVELOPMENT CENTER <br />285 Church St NE · Room 132 <br /> Salem, OR 97301 <br /> <br />24 Hr In~poction Line: 588-7904 <br />Offico: 588-5147 8:00 a.m. - 4:30 p.m. <br />FAX: 588-7948 <br /> <br />IMECHANICAL PERMIT APPLICATION <br />Please complete all ,~ctions, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <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 Judson' s t Inc. ] Phone 363-4141 <br />Mailing Address P.O. l~X 1 2669 <br /> <br />Salem OR 97309 <br /> <br />Contractor's License No. 24-22PB <br /> <br />Co.tractor's ~ard Reg. No. 34604 <br /> <br />Contractor's Signature: <br /> <br />2B. FOR OWHER INSTALLATIONS <br />Property Owner (please prim) <br />Mailing Address Phone <br />City/State/Zip <br />Owner's Signature: <br />Agent's Signature: <br /> <br />3. PLAN REVIEW SECTION <br /> <br />PERMIT NO' <br />Date: <br /> <br />Issued by: <br /> <br />4. FEE SCHEDULE (Complete and enter total in Al below) <br /> <br /> RESIDENTIAL [~ COMMERCIAL [~ <br /> USE OF STRUCTURE: <br /> NEW ~ ALTERATION El ADDITION [~ RELOCATION <br /> <br />GAS El or ELECTRIC El <br /> <br />BASE FEE <br /> <br />FORCED AIR FURNACE <br /> up to 100,000 BTU <br /> over 100,000 BTU <br /> <br />Floor Fumace <br />Suspended Heater <br />Wall Heater <br />Floor Mounted Heater <br /> <br />HEAT PUMP <br /> under 3 Ton <br /> 3 Ton and up <br /> <br />AIR CONDITIONER <br /> under 3 Ton <br /> 3 Ton and up <br /> <br />EvaporativeCooler <br />Commercial Exhaust System <br />Commercial Hood and Exhaust <br />Domestic Range Hood <br />Domestic Exhaust Fans NO,- <br /> and Dryer Vents <br />Fire Damper <br />Wood Stove/Fireplaea <br />Furnace Ducts (Alteration/Extension) <br />Commercial / Industrial Incinerator <br /> <br />No. X <br /> <br />$ 6.00 <br />$ 7.0O <br /> <br />$ 6.O0 <br />$ 6.O0 <br />$ 6.OO <br />$ 6.00 <br /> <br />$ 6.50 __ <br />$11.00 __ <br /> <br />$ 6.50 __ <br />$11.00 __ <br /> <br />$4.50 <br />$4.50 <br />$4.50 <br />$4.50 <br /> <br />$ 3.00 <br />$3.00 <br />$7.5O <br />$7.50 <br />$3o.oo __ <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 appliance permit <br /> <br />OTHER (as required by Buil&qg Ol~ciaD <br /> <br />DWELLING PERMIT LABEL <br /> <br /># of Labels <br /> <br />$7.50 <br />$7.50 <br />$7.50 <br />$ 7.5O <br /> <br />$ 2.00 <br />$ .50 __ <br /> <br />$ 3.00 __ <br /> <br />N/C <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 />5. FEES <br /> Al. Enter total of fees from Sec. #4 <br /> A2. Add 5% surcharge (.05 x Al) <br /> <br />Subtotal <br /> <br />B. Enter 25% of line A 1 ibr Plan Review <br /> (A 1 + .25), if required <br />C. investigation Fee (if required) <br />D. Reinspection Fee ($25.00) <br /> <br />TOTAL AMOUNTDUE <br /> <br />$, Ic2,6,0 <br /> <br />MC 15-41 Receipt No. <br />Rev. 12/94 <br /> <br /> <br />