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FOR CITY VALIDATION <br />Received by: <br />Date: <br /> <br />IMECHANICAL PERMIT APPLICATION <br />P/ease complete al~ Sections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />MARION <br /> COUNTY <br /> BUILDING <br /> INSPECTIO~ ~,~ <br /> COMMUNITY DEVELOPMENT CENTER <br /> 285 Church St NE · Room 132 <br /> Salem, OR 97301 <br /> <br /> ~ Hr In~t~n L~e: 58~7~ <br /> OW~: 588-5147 8:~ a.m. - 4:30 p.m. JSSU~ b~ARION COII~TY <br /> ss-? 4s BUILDING INSPECTION <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. COHTRACTOR INSTALLATION ONLY <br /> <br />g6~ <br /> <br />Contractor <br /> <br />Mailing Address <br /> <br />Contractor's License No. <br />Contractor's Board Reg. No. /~(~ [ lob No. ~.,~t/7 <br />Contractor's Signature: r~~. ~.~ <br /> <br />2B, FOR OWNER INSTALLATIONS <br /> <br />Property Owner (please print) <br /> <br />Mailing Address <br /> <br />Phone <br /> <br />City/State/Zip <br /> <br />Owner's Signature: <br /> <br />Agent's Signature: <br /> <br />4. FEB SCHEDULE (Complete and enter total in Al below) <br /> <br /> RESIDENTIAL l~ COMMERCIAL 12] <br />USE OF STRUCTURE: <br />NEW ~ ALTERATION 1~ ADDITION I~ RELOCATION 121 <br /> <br /> GAS ~ or ELECTRIC D <br /> No. X Fee =, Sum <br />BASE FEE $10.00 <br /> <br />FORCED AIR FURNACE <br />up to 100,000 BTU / $ 6.00 <br />over I00,000 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 />EvaporativeCooler $ 4.50 <br />Commercial Exhaust System $ 4.50 <br />Commercial Hood and Exhaust $ 4,50 <br />Domestic Range Hood $ 4.50 <br />Dotnestie Exhaust Fans <br />and Dryer Vents $ 3.00 <br />Fire Damper $ 3.00 <br />Wood Stove/Fireplace $ 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 _~.,,~0 <br />Gas Log Lighter $ 7.50 <br />Gas Barbeque $ 7.50 <br />Other $ 7.50 <br /> <br />GAS PIPING SYSrYEM <br />14 outlets (per outlet) ~ $ 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 (ss required by Building Ot~ciaO <br /> <br />DWELLING PERMIT LABEL #of Labels <br /> <br />NIC <br /> <br />3. PLANREVIEW 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 />MC 15-41 <br />Rev. 12/94 <br /> <br />5. FEES <br /> Al. Enter total of fees fwm Se~. #4 <br /> A2. Add 5% surcharge (.05 x Al) <br /> Subtotal <br /> <br /> B. Enter 25% of line A 1 for Plan Review <br /> (A 1 + .25), if required <br /> C. Investigation Fee (if required) <br /> D. Reimpeetion Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUB <br /> Receipt No. <br /> <br />$ <br /> <br />$~ <br /> <br />s <br /> <br /> <br />