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I <br />FOR CITY VALIDATION [ <br />Received by: <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br />COMMUNITY DEVELOPMENT CENTER <br />285 Church St NE · Room 132 <br /> Salem, OR 97301 <br /> <br />MECHANICAL PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />24 Hr In,portion Line: 588-7904 <br />Office: 58a-5147 8:00 a.m. - 4:3O p.m. Issued by: i¥'l~Ffi~['4 C0~J't'!~¥ <br /> <br /> 4. FEE SCHEDULE (Comolcte and enter total ia Al below) <br /> <br />JobAddress 1 I 648 Kingfisher NE <br /> <br />ci~ Aurora c~ st Meadow <br />P~m.yOw~ Doran Chapman P~e 678-5884 <br /> <br />D~cdp~a~ctm~ From Arndt Rd turn riqht <br />onto Meadow and left on Kingfisher. <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT <br /> STARTED WITHIN 180 DAYS OF ISSUANCE OR 1F <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br /> RESIDENTIAL ~. COMMERCIAL <br /> USE OF STRUCTURE: awe±~.x ng <br /> NE~ ~ AL~RATION ' ' ~D~ION ~ R~OCATION <br /> GAS ~ or ELEC~IC ~ <br /> No. X F~ <br />BASE FEE <br /> <br />FORCED AIR FURNACE <br />up to 100,000 BTU $ 6.00 <br />over 100,000 BTU $ 7.00 <br /> <br />HoorFumace $ 6.00 <br />Suspended Heater $ 6.00 <br />Wall Heater $ 6.00 <br />HoorMountedHeater $ 6.00 <br /> <br />Oreqon Heating & Coolin~ <br />Cont~aor / Phone 581--8747 <br /> <br />MaillngAddr~s2365 Front St, Salem, 97303 <br /> <br />HEAT PUMP <br />under 3 Ton I $ 6.50 6.5 0 <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 />Contractor's License No. <br /> // <br />I I Fire Damper <br />, Wood Stove/Fireplace <br />Contractor s Board Reg. No. ~'~~ J~ No. /C I ] _ <br />-- ~'~ t ~ / .,~t-- // /~] ] Furnace Ducts (Alteration/l~xtension) <br /> ~ ~ ( I .~'~",,. / //I% , / - ///I ] Commercial / Industrial Incinerator <br /> <br /> ~ ~~ G~ Log Lighter <br />21t. FOR OWNER INSTALLATIONS G~ Barbeque <br /> Other <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 /> $ 3.00 <br /> $ 7.50 <br /> $ 7.50 <br /> $30.00 __ <br /> <br />GAS PIPING SYSTEM <br /> 1-4 outlets (per outlet) <br /> 4 and up outlets (per outlet) <br /> <br />Appliance Vents not included in <br />an appliance permit <br /> <br />OTHER (as requived by Bnila~'qg Ot~ciM) <br /> <br />DWELLING PERMIT LABEL # of Labels <br /> <br />Property Owner (please print) <br />Mailing Address Phone <br />City/Slate/Zip <br />Owner's Signature: <br />Agent's Signature: <br /> <br />$ 7.50 <br />$ 7.5O <br />$7.5O <br />$ 7.50 <br /> <br />$ 2.00 <br />$ .5o <br /> <br />$ 3.00 <br /> <br />N/C <br /> <br />3. PLAN REVIEW 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 />5. FEES <br /> Al. Enter total of fees from S~c. #4 <br /> A2. Add 5% surcharge (.05 x Al) <br /> 8ubtotal <br /> <br /> B. Enter 25% of line A 1 for Plan Review <br /> (A l + .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 />$16.50 <br />$ <br /> <br />$17.33 <br /> <br /> <br />