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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 />MARION COUNTY BUILDING INSPECTION <br /> <br /> 285 Church St NE · Room 132 ~ _ · <br /> Salem, OR97301 ' <br /> 24 Hr Inspection Line: 588-7904 i! <br /> <br /> Offme: 588-5147 8:00 a.m. - 4:30 p.m. ISsuod t~,~ ~:; ,~ ~/ <br /> <br /> 4. FEE SCHr~D~ (Complete and enter totaJ in Al below) <br /> <br /> [] <br /> USE OF STRUCTURE: <br /> NEW ~ ALTERATION ~ ADDITION ~i~R_.~ELOCATION <br /> GAS ~ or ELECTRIC ~ <br /> / <br /> <br />J PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT J <br /> I <br />STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br />WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. COHTRACTOR INSTALLATION ONLY <br />Contracto~ff/~' ~/~ ~7~]~_~ ~on~--~ <br />MailingAdd~s ~~~ ~ ~ ~' ' <br /> . ~ <br /> <br />Con~ctor's License No. <br /> <br />Contractorls Board Reg.~ ~~ I lobNo. <br /> <br />211. FOR OWNER INSTALLATIONS <br /> <br />Property Owner (please prim) <br />Mailing Address Phone <br />City/State/Zip <br />Owner's Signature: <br />Agent's Signature: <br /> <br /> No. X Fo~ ,~ 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 <br />Commercial Exhaust System <br />Commercial Hood and Exhaust <br />Domestic Range Hood <br />Do/nestic Exhaust Fans <br /> and Dryer Vents <br />Fire Damper ~/[~. <br />Wood Stove/Fi/~p~lace <br />Furnace Ducts (Alteration/Extension) <br />Commercial / Indus~al Inclnerntor <br /> <br />ADDITIONAL APPLIAHCES <br /> Gas Water Heater <br /> Gas Log Lighter <br /> Gas Barbeque <br /> Other <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 (ss wquired by Buil~'~g Ofdciai) <br /> <br />DWELLING PERMIT LABEL //of Labels <br /> <br />$4.50 <br />$4.50 <br />$4.50 <br />$4.5O <br /> <br />$ 3.00 <br />$ 3.00 <br />$7.50 <br />$ 7.50 <br />$30.00 <br /> <br />$ 7.50 <br />$ 7.50 <br />$7.50 <br />$ 7.5O <br /> <br />$ 30 <br /> <br />$ 3.00 <br /> <br />N/C <br /> <br /> 3. PLANREVIBW SECTION <br /> <br /> Marion County does not require a plan review. <br />I We will provide plan review service if you complete <br />[ Section SB and submit two (2) sets of plans and <br />Ispecifications with this application. <br /> <br />MC 15-4 1 <br />R~v. 12/94 <br /> <br />5. FEES <br /> Al. Enter total of fees from S~.//4 <br /> A2. Add 5% surcharge (.05 x Al) <br /> Subtotal <br /> <br /> B. Enter 25% of line Al for Piun Review <br /> (A 1 + .25), if r~quired <br /> C. Investigation Fee (if required) <br /> D. Reinspection Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br /> Receipt No. __ <br /> <br /> <br />