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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 ~a ~ ~ <br />COMMUNITY DEVELOPMENT CENTER ..... ~1 <br /> 285 Church St NE · Room 132 ~-'~'~M~ <br /> Salem, OR 97301 ~P~ 1 ~ ~ <br /> Date: <br /> COUNTY <br /> z4 Hr m,,p, tio, by-BUILDING INSPECTION <br /> 0~: 588-5147 8:~a.m.-4:3Op.m. ISSU~ . <br /> <br /> USE OF ~RUCT~E: <br /> NEW O AL~RATION ~ ~DfflON D ~OCATION <br /> <br />IPERMITS ARE NON-TRANSFERABLE AND EXP1RE IF WORK IS NOT [ <br /> I <br /> STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> 2A. CONTRACTOR INSTALLATION ONLY <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 SBCTION <br /> <br /> GAS,~ or ELECTRIC <br />BASE FEE <br /> <br />No. X <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 />Commercial / 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 outlet) <br /> 4 and up outlets (per outlet) <br /> <br />Appliance Vents not included in <br />an appliance permit <br /> <br />OTHER (as required by Bulling Olt?ciaO <br /> <br />DWELLING PERMIT LABEL # of Labels <br /> <br />$ 6.oo <br />$ 6.00 <br />$ 6.00 <br />$ 6.00 <br /> <br />$ 6.50 <br />$11.00 <br /> <br />$ 6.50 <br />$11.00 __ <br /> <br />$ 4.5O <br />$4.50 <br />$ 4.50 <br />$4.50 <br /> <br />$ 3.00 <br />$ 3.00 <br />$ 7.5O <br />$7.5O <br />$30.00 ~ <br /> <br />$7.50 <br />$ 7.50 <br />$ 7.50 <br />$ 7,50 <br /> <br />$ 2.00'~ <br />$ .50 <br /> <br />$ 3.00 __ <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 />5. FEES <br /> A I. Enter total of fees from See.//4 <br /> A2. Add 5% surcharge (.05 x Al) <br /> <br />Subtotal <br /> <br />B. Enter 25% of line A I for Plan Review <br /> (A 1 + .25), if required <br />C. Investigation Fee (if required) <br />D. Reinspection Fee ($25.00) <br /> <br />Receipt No. <br /> <br />TOTAL AMOUNT DUE <br /> <br /> <br />