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I <br />FOR CITY VALIDATION [ <br />Received by:, <br />Date: <br /> <br />MARION COUNTY BUILDING INSP C ION <br /> COMMUNITY DEVELOPMENT CENTER <br /> 285 Church St NE · Room 132 PERMIT NO · <br /> Salem, OR 97301 <br /> <br />24 Hr Inspection Line: 588-7904 <br />Office: 588-5147 8:00 a.m. - 4:30p.m. <br />FAX: 588-7948 <br /> <br />IMECHANICAL PERMIT APPLICATION <br />Please complete all Sections, I through $ <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />City <br />l~cription/Ddirectiom <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 /> <br />Con ctor'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/State/Zip <br />Owner's Signature: <br />Agent's Signature: <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 1541 <br />Rev. 12/94 <br /> <br />Date: <br /> <br />Issued by: <br /> <br />4. FEE SCHEDULE (Complete and enter total in Al below) <br /> <br /> RESIDENTIAL [~ COMMERCIAL [] <br /> USE OF STRUCTURE: <br /> NEW ~] ALTERATION ~ ADDITION ~ RELOCATION <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 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 $ I 1.00 __ <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 />Fire Damper $ 3.00 <br />Wood Stove/Fireplaea $ 7.50 <br />Furnace Ducts (Alteration/Extension) ~ $ 7.50 <br />Commercial / Industrial Incinerator $30.00 <br /> <br />ADDITIONAL APPLIANCES <br />Gas Water Heater X ' $ 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~g Oglfciai) <br /> <br />DWELLING PERMIT LABEL # of Labels <br /> <br />5. FEES <br /> Al. Enter total of fees from See.//4 <br /> A2. Add 5% surcharge (.05 x Al) <br /> Subtotal <br /> <br /> B. Enter 25% of line A 1 for Plan Review <br /> (Al + .25), if required <br /> C. Investigation Fee (if required) <br /> D. Rein~pection Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br /> Receipt No. <br /> <br /> <br />