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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 /> Issu~l by: <br /> <br />24 Hr Inspection Line: 588=7904 <br />Off'w,e: 588-5147 8:00 a.m. - 4:30p.m. <br />FAX: 588-7948 <br /> <br /> MECHANICAL PERMIT APPLICATION <br /> Please complete all Sections, I through $ <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />Descfipfiun/l~ir~tious <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT [ <br /> ! <br /> <br /> STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. COHTRACTOR INSTALLATION ONLY <br />Contractor~%~. _~_ ~_~k~.C~{~,O~ x ~ ~one~~ <br />Mailing Add~s ~ ~ ~~~~ <br /> <br />Contractor's License No. <br /> <br />Contractor's Boara Reg. No. ~I~2~'~ ~'D '~0 ] JobNo. <br /> <br />2B. FOR OWNER INSTALLATIONS <br />Property Owner (please print) <br />Mailing Address Phone <br />City/State/Zip <br />Owner's Signature: <br />Agent's Signature: <br /> <br />3. PLANREVIEW SECTION <br /> <br />4. FEE SCHEDULE (Complete and enter total in A1 below) <br /> <br /> RESIDENTIAL [~ COMMERCIAL <br /> USE OF STRUCTURE: <br /> NEWxC~ ALTERATION El ADDITION [] RELOCATION <br /> GAS~ or ELECTRIC <br /> / <br /> No. X Pe~ = Sum <br />BASE FEE $10.00 <br /> <br />FORCED AIR FURNACE <br />up to ~oo, ooo s~ i s 6.oo ~ ~ <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 Rnnge Hood $ 4.50 <br />Domestic Exhaust Fans <br />and Dryer Vents $ 3.00 <br />Fire Damper $ 3.00 <br />Wood Stove/Fireplace $ 7.50 <br />Furnace Docts (Alteration/Extension) $ 7.50 <br />Commercial / Industrial Incineretor $30.00 <br /> <br />ADDITIONAL APPLIANCES <br />Gna Water Heater $ 7.50 <br />Gna Log Lighter $ 7.50 <br />Gas Barbeque $ 7.50 <br />Other $ 7.50 <br /> <br />GAS PIPING SYSTEM <br /> 1-4 outlet~ (per outlet) <br /> 4 and up outlets (per outle0 <br /> <br />Appliance Vents not included in <br />an appliance permit <br /> <br />OTHER (as wquired by Build~o~ Ol~ciaD <br /> <br />DWELLING PERMIT LABEL # of Labels <br /> <br />s 2.o0 q.cO <br />$ 30 <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 />MC 15-41 <br />Peg 12/94 <br /> <br />5. FBB$ <br /> Al. Enter total of fees fwm Sec.//4 <br /> A2. Add 5% surcharge (.05 x Al) <br /> Subtotal <br /> <br /> B. Enter25% of line Al for Plan Review <br /> (Al + ,25), if required <br /> C. Investigation Fee (if required) <br /> D. Reiuspection Fee ($:25.00) <br /> <br /> TOTAL AMOUNT DUE <br /> Receipt No. <br /> <br />$~ <br />$, <br />$ <br /> <br /> <br />