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FOR CITY VALIDATION <br />Received by: <br />Date: <br /> <br /> MECHANICAL PERMIT APPLICATION <br /> Please complete all Sections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br /> ? <br />MARION COUNTY BUILDING INSPECTIO~]~'] <br /> COMMUNITY DEVELOPMENT CENTER <br /> <br /> Salem, OR 97301 _14. ~,~ ~% I!11 <br /> <br /> Offi~: 588-5147 8:~ a.m. - 4:30 p.m. Jssu~ <br /> F~:588-7948 ~ - ~ uj~ly <br /> 8UILDI INSPECTiO t <br /> 4. F~ SCH~ (Complete and ent~ ~al ~ Al ~low) <br /> <br />Desetipfion/Ddim~6om <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT <br /> I <br /> STARTED WITHIN 1~0 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />Contractor's License No. ~ <br /> <br />Co., actor's Soa Reg. No. /44x g I No. <br /> <br />2B. FOR OWHER INSTALLATIONS <br />Property Owner (please print) <br />Mailing Address Phone <br />City/State/Zip <br />Owner's Signature: <br />Agent's Signature: <br /> <br /> RESIDENTIAL ~ COMMERCIAL [~ <br />USE OF STRUCTURE: <br />NEWJR, ALTERATION [2 ADDITION [3 RELOCATION El <br /> <br /> GAS ~ or ELECTRIC [~ <br /> <br />BASE FEE <br /> <br />FORCED AIR FURNACE <br /> up to 100,000 BTU <br /> over 100,000 BTU <br /> <br />Floor Furnace <br />Suspended Heater <br />Wall Heater <br />Floor Mounted Heater <br /> <br />HEAT PUMP <br /> under 3 Ton <br /> 3 Ton and up <br /> <br />AIR CONDITIONER <br /> under 3 Ton <br /> 3 Ton and up <br /> <br />EvaporativeCooler <br />Commercial Exhaust System <br />Commercial Hood and Exhaust <br />Domestic Range Hood <br />Domestic Exhaust Fans <br /> and Dryer Vents <br />Fire Damper <br />Wood Stove/Fireplace <br />Furnace Ducts (Alteration/Extension) <br />Com~nercial / Industrial Incinerator <br /> <br />ADDITIONAL APPLIANCES <br /> Gas Water Heater <br /> Gas Log Lighter <br /> Gas Barbeque <br /> Other <br /> <br />GAS PIPING SYSTEM <br /> 1-4 outlets (per oufle0 <br /> 4 and up outlets (per outle0 <br /> <br />Appliance Vents not included in <br />an appliance permit <br /> <br />OTHER (ss required by Buil~gg Ot~eisl) <br /> <br />DWELLING PERMIT LABEL # of Labels <br /> <br />No. X Fe~ ~ 8urn <br /> Szo. o0 <br /> <br />/ $ 6.00 <br /> $?.oo <br /> <br />$ 6.00 <br />$ 6.00 <br />$ 6.00 <br />$ 6.00 <br /> <br />$ 6.50 <br />$11.00 <br /> <br />$ 6.50 <br />$11.00 <br /> <br />$4.50 <br />$4.50 <br />S4.50 <br />$4.50 <br /> <br />$ 3.00 <br />$ 3.00 <br />$?.50 <br />$7.50 <br />$30.00 <br /> <br />$7.50 <br />$7.50 <br />$7.50 <br />$7.50 <br /> <br />$ 2.00 <br />$ 30 <br /> <br />$ 3.00 <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 ~B and submit two {2) sets of plans and <br />specifications with this application. <br /> <br />MC 15-41 <br />l~ v. 12/94 <br /> <br />5. FEES <br /> Al. Enter total of fees from Sec. #4 <br /> A2. Add 5% surcharge (.05 x Al) <br /> Subtotal <br /> <br /> 13. Enter25% of line A1 for Plan Review <br /> (Al + .25), ifr~quired <br /> C. Investigation Fee (it'required) <br /> D. Reinspection Fee ($25.00) <br /> <br /> TOTAL AMOWNT DUB <br /> Receipt No. <br /> <br />$ ~7o <br />$.~ <br /> <br />$.~ <br />$.~ <br /> <br /> <br />