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FOR CITY VALIDATION <br />Received by: <br />I~te: <br /> <br />MARION COUNTY BUILDING INSPECTION <br />COMMUNITY DEVELOPMENT CENTER <br />285 Church St NE · Room 132 <br /> Salem, OR 97301 <br /> <br />24 Hr Inspection Line: 588-7904 <br />Off'~,e: 588-5147 8:00 a.m. = 4:30 p.m. <br />FAX: 588-7948 <br /> <br />MECHANICAL PERMIT APPLICATION <br />I~ease complete all Sections, I through § <br /> <br />1. LOCATION OF INSTALLATION <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 /> <br />Contractor's Licen~ No. <br /> <br />213. FOR OWNI~R INSTILLATIONS <br /> <br />Property Owner (plea~ prim) <br /> <br />Mailing Address I <br /> Phone <br /> <br />City/State/Zip <br /> <br />Owner'n Signn~m'e: <br /> <br />Agent's Sigtmture: <br /> <br />3. PLANRBVII~W SttCTION <br /> <br /> MARION COUNTy <br /> I~llll rl~,~ ~,,.. <br /> <br /> ~SIDE~I~ ~ COMMERCI~ 0 <br />USE 9Y ~RU~ ~ ~ _ <br />N~ AL~RATION ~ ~DfflON ~ ~ATION <br />GAS '0 or ~E~iC ~ <br /> / ~ X F~ m Sum <br /> <br />BA~E FEE $10.00 <br /> <br />FORCED AIR FURNACE ' <br />up to 100,000 BTU $ 6.00 <br />over 100,000 BTO $ 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 $1 !.00 <br /> <br />AIR CONDITIONER <br /> under 3 Ton <br /> 3 Ton and up <br /> <br />EvaporativeCooler <br />Commercial Exhaust System <br />Commercial Hood and Exhaust <br />Domestic Range Hood <br />Domestic Exhaust Fans <br /> and Dryer Veins <br />Fire Damper <br />Wood Stove/Fireplace <br />Furnace Ducts (Alteration/Extension) <br />Commercial / Industrial Incinerator <br /> <br />ADDITIONAL APPLIANCE8 <br /> ~3as Water Heater <br /> Gas bog Lighter <br /> Gas Barboqne <br /> O~her <br /> <br />GA8 PIPINO SYSTEM <br /> I-4 outlets (per outlet) <br /> 4 and up outlets (per outlet} <br /> <br />Appliance Vents not included in <br />an appliance i~rmil <br /> <br />OTHER (as required by Bu~ldng Oltfc~O <br /> <br />DWELLINO PI~RMIT LABEL #of Labels <br /> <br />$ 6.50 <br />$11.00 <br /> <br />$4.50 , · <br />$4.50 <br />$4.5O <br />$4.5O <br /> <br />$ 3.00 <br />$3.00 . <br /> <br />$ 7.50 <br />$30.00 , <br /> <br />$ 7.50 <br />$7.5O <br />S 7.50 <br />$7.50 <br /> <br />$ 2.00 <br />$ <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. FliES <br /> A I. Enter total of fees from Sec. ~4 <br /> A2. Add 5% au~haxge (.05 x Al) <br /> Subtotal <br /> <br /> B. ~ter 25% of I~e A I for PI~ Review <br /> (Al + .25), if ~u~d <br /> C. lnvestigat~n ~e (if~qui~) <br /> D. Rei~ct~n ~ ($25.~) <br /> <br /> TOT~ ~O~ DUE <br /> Receipt No. <br /> <br /> <br />