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FOR CITY VALIDATION <br />R~eived by: <br />Date: <br /> <br /> MECHANICAL PERMIT APPLICATION <br /> P/ease complete ail Sections, I through $ <br /> <br />1. LOCATION OF INSTALLATION <br /> <br /> 285 Church St NE · Room 132 I-'l=l-IMll i~lU: <br /> Salem. OR 97301 Date: ~ ~ <br /> 24 Hr Inspection Linz: 588-7904 <br /> Off'we: 588-5147 8:00 a.m. - 4:30 p-m. Issued by: <br /> FAX: 588-7948 <br /> <br /> 4. Fi~E SCI.[F:~[JLFi (Complete ,,nd enter ~o~1 i~l <br /> <br /> RESIDPNTIAL ~ COMMP. R~AL <br /> USE OF STRUCTURE: ,, <br /> NEW (2 ALTERATION~t~ADDITION [2 RELOCATION r-l <br /> GAS~ or E].~CTRIc ct <br /> No. X Pe= = 8urn <br /> BASE FEE $10.00 <br /> <br /> FOeCBD ~ FUeNACB - _ ~'/ <br /> ~o too, ooo~ru ,~. t~0,. / 1. s 6.oo <br /> ovcr ]00,000 BTU ,,," {],~k./'_\/ 27.00 <br /> <br /> Suspended Hcater ' ,~ \ m TM __ _ $ 6.00 <br /> WaN Heater ~' ~ $ 6.00 <br /> $ 6,00 <br /> FJ°°r M°unted Heater <br /> <br /> under 3 Ton 5 \,~.,L; ~L.'~ $ 6.50' . <br /> 3 Ton and up f~- ~1,~ $11.00 <br /> Evaporatlv~ool~r $ 4.50 <br /> Commercial Exhaust System $ 4~50 <br /> Commercial Hood and ILxhaUSt $4;50 <br /> Domestic Range Hood $ ~.50 <br /> Domestic Exhaust Fans <br /> and D~e~ Vents $ 3.00 <br /> Fir~ Damp~ $ 3,00 <br /> Wood Stove/Fk~plne¢ $ 7..50 <br /> Furnace Ducts (Aiteratio~/Extendoo) $ 7.50 <br /> Comm~rcia{ / Industrial Incinerator - $.30.00 <br /> <br /> ADDITIONAL APPLIANCE8 <br /> Oa~ Water Heater $ 7.50 <br /> Oas Log Lighter $ 7.50 <br /> oas ~ae~ $ 7.50 ' <br /> other $ 7.50 . <br /> <br /> GAS PIPING SYSTEM ~. . <br /> 1-4 outl~ (pm-Gdt{et) ~ ~ $ 2;00 <br />Phon~ 4 and UP Outlets (,per oudet) ~ <br /> Appliance'Vents not included in <br /> , , an aPpliance permit $ 3.00 <br /> OTFIYgR' (~s requiredby 11ttt'lda~ Ol~ial) <br /> DW-BLIblNO I'BRMiT LABEL #ofLabel~ <br /> <br /> Al. Emer total 0f:fees fromS~.//4 $ <br /> <br /> 8ub~mal - $ <br /> <br /> B. Emcr 25% of line Al for Plan Review <br /> (Al + .25), if ~quir~d <br /> C. Inv~tigaiion F~ (if~equimd) $ . <br /> D. Reinspe¢iion Fe~ (S25;005: ' $__ <br /> <br /> TOTAL AMOUNT DUB $., <br /> Rccci.pt No. <br /> <br />{~R1VIIrS ~ NONTTP, AJqSI~I~itABLF- AND EX'~ ~ WO~ IS NOT ] <br /> ~AR~ ~m IW DAYS OF ISSU~ OR IF · <br /> WOrm SUS~ F~ 1~ DAYS. <br /> <br /> ~mr,s ~ No, <br /> <br />Contnetot's $i~atu~: <br /> <br />2B..:FOR. 0WiqliRmSTALLATiON$ <br /> <br />Prope~ Owner'/o~, <br /> <br />city/sm~r~ <br /> <br />Ow~r!~ Si~atut~: <br /> <br />3. PKAN~ 81~"TION <br /> <br />MadonCoUnty does not:require a plan revieW. <br />We wi!l provid~ p!anreview service if you complete <br />SectiOn: 5B andsubmit'twO (2)sets of plans and <br /> speeificafiOn~ :with this .application. <br /> <br />~ 15-41 ' <br /> <br /> <br />