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FOR CITY VALIDATION <br />Received by: <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTICI[~ <br /> <br /> Salem, OR 97301 <br /> Date: BUIErIIAI~ ~,~ <br /> ...... ~urcb ! IU~ <br /> ~ Hr ln~n L~e: 58~7~ <br /> OW~ 58~5147 8:~ a.m. - 4:30 p.m. 188~ <br /> F~: 588-7948 <br /> <br /> MECHANICAL PERMIT APPLICATION <br /> P/ease complete all Sections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <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 />Contractor's License No. <br /> <br />Contractor's Signatur~~~ ~ <br /> <br />~.l=t. FOR OWNER INSTALLATIONS <br /> <br />Property Owner (ple~seprim) <br />Mailing Address Phone <br />City/State/Zip <br />Owner's Signature: <br />Agent's Signature: <br /> <br />4. FEE SCHEDULE (Complete and enter total in Al below) <br /> <br /> RESIDENTIAL ~= COMMERCIAL O <br /> USE OF STRUCTURE~ <br /> NEW O ALTERATION ~ ADD1TION~I.II~.,OCATION <br /> GAS ~ or ELECTRIC ~1 <br /> <br /> No. X Fm= 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 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 />Domestic Exhaust Fans <br />and Dryer Vents $ 3.00 <br /> <br />Furnace Ducts (Alteration/Extension~- qe~ ..... $ 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 SYgI'BM <br />1-4 outleU~ (per Guile0 $ 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 r~quired by 8uil~ag Ol~ciai) <br />DWELLING PERMIT LABEL # of Labels N/C <br /> <br />3. PLANREVIBW 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 1.5-41 <br />R~v. 12/94 <br /> <br />5. FRBS <br /> Enter total of fees from Sec.//4 $~ <br /> Al. <br /> A2. Add 5% surcharge (.05 x Al) $.~/.~.~ <br /> ~ubtotal <br /> <br /> B. Enter 25% of llnc Al for Plan Review <br /> (Al + .25), if required $ ~ <br /> C. Inv~tigation Fee (if required) $... ~ <br /> D. Rciuspection Fee ($25.00) ~ ~ <br /> <br /> Receipt No. <br /> <br /> <br />