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FOR CITY VALIDATION <br />Received by:~ <br />Date: <br /> <br />IMECHANICAL PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />L LOCATION OF INSTALLATION <br /> <br />MARION COUNTY BUILDING INSPECT][~fflN~ ~ ~ ._.______.__~ <br />COMMUmrY DSW. LOPM T CSm R <br />285 Church St NE · Room 132 <br /> ' <br /> Salem, OR 97301 <br /> D~e: <br /> <br /> F~: 58~7948 <br /> ~UILDI~G iN~PEOTio~ <br /> 4. F~ SC~~ (Complete and ent~ ~=1 ~ Al below) <br /> <br />Description/[kiirections <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT <br /> STARTED wrrHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. COHTRACTOR INSTALLATION ONLY <br /> <br />Contractor <br /> <br />Mailing Address <br /> <br />Contractor's License No. <br />Contractor's Board Reg. No. b%~ Job No. <br />Contractor's Signature: <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. PLANREVIBW SECTION <br /> <br /> RESIDENTIAL [] COMMERCIAL [] <br /> USE OF STRUCTURE: <br /> NEW ~1 ALTERATION D ADDITION C} RELOCATION <br /> GAS ~1 or ELECTRIC F~ <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 100,000 BTU $ 7.00 ~ <br /> <br />Floor Furnace $ 6.00 <br />Suspended Heater $ 6.00 <br />Wall Heater $ 6.00 <br />Floor Mounted Healer $ 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 Rnnge Hood $ 4.50 <br />Dotnestic 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 lncinerntor $30.00 <br /> <br />ADDITIONAL APPLIANCES <br />Gas Water Heater $ 7.50 <br />Gas Log Lighter $ 7.50 <br />Gas Barbeque $ 7.50 <br />Olher $ 7.50 <br /> <br />GAS PIPING SYSTEM <br />1-4 outlets (per outlet) $ 2.00 -- <br />4 and up outlets (per outle0 $ .50 <br /> <br />Appliance Vents not included in <br />an appliance permit $ 3.00 <br /> <br />OTHER (as required by 8uil&'ng Ot~ci~O <br /> <br />DWELLING PERMIT LABEL //of Labois <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 />Rev. 12/94 <br /> <br />5. FRRS <br /> Al. Enter total of fees from Sec.//4 <br /> A2. Add 5% surcharge (.05 x Al) <br /> Subtotal <br /> <br /> B. Enter 25% of line Al for Plan Review <br /> (A 1 + .25), if required <br /> C. Investigation Fee (if required) <br /> D. Reinspection Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br /> Receipt No. <br /> <br />s <br />$__ <br />$__ <br /> <br />$__ <br />$__ <br />$__ <br /> <br /> <br />