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I <br />FOR CITY VALIDATION [ <br />Received by: <br />Date: <br /> <br />COMMUNITY DEVELOPMENT CENTER <br />285 Church St NE · Room 132 <br /> Salem, OR 97301 <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br /> PERMIT NO: <br /> <br /> Date: <br /> <br /> Issued by: <br /> <br />IMECHANICAL PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />24 Hr Inspection Line: 588-7904 <br />Off.we: 588-5147 8:00 a.m. - 4:30p.m. <br />FAX: 588-7948 <br /> I <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 />Contractor ~/~ ~_J~'~'~.~'~-~ Phone <br /> <br />Mailing Address <br />Contractor's License No. <br />Contractor's Board Reg. No. Job No. <br />Contractor's Signature: <br /> <br />2B. FOR OWNER INSTALLATIONS <br />Property Owner (please print) <br />Mailing Address Phone <br />City lStatef-Zip <br /> <br />3. PLAN REVIEW 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 />4. FEE SCHEDULE (Complete and enter total in A1 below) <br /> <br /> RESIDENTIAL ~ COMMERCIAL [~ <br /> USE OF STRUCTURE: <br /> NEW [] ALTERATION [] ADDITION CI RELOCATION <br /> <br /> GAS [] or ELECTRIC D <br /> No. X Fe~ = 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 POMP <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 />Do,nestle Exhaust Fans <br />and Dryer Vents $ 3.00 <br />Fire Damper $ 3.00 <br />Wood Stove/Fireplace ff $ 7.50 ~d~ <br />Furnace Ducts (Alteration/Extension) $ 7.50 <br />Commercial / Industrial Incinerator $30.00 ~ <br /> <br />ADDITIONAL APPLIANCES <br />Gas Water Heater $ 7.50 <br />Gas Log Lighter $ 7.50 <br />Gas Barbeque $ 7.50 <br />Other $ 7.50 <br /> <br />GAS PIPING SYSTEM <br />1-4 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 (as required by Buil&'t~ Ol~ciai) <br />DWELLING PERMIT LABEL # of Labels NIC <br /> <br />5. FEES <br />A 1. Enter total of fees from Sec. g4 $ <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. Reiuspection Fee ($25.00) $.~ <br /> <br /> TOTAL AMOUNT DD'~ $.~ <br /> Receipt No. <br /> <br /> <br />