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FOR CITY VALIDATIONI <br />Received by:~ <br />Date: <br /> <br />COMMUNITY DEVELOPMENT CENTER _.~ ~.~ ~._ <br />285 Church St NE · Room 132 <br />Salem, OR 97301 <br /> Date: <br />24 Hr Inq~dion Lina ~88-7904 ~/~HION COUNTY <br />oe-,~ 5~-5~47 s:oo.~.-4:~op_,,, issued~[LDINC~ <br /> <br /> I <br /> MECHANICAL PERMIT APPLICATION ] <br /> I <br /> Ploaso comploto all 8oations, I through 5 <br /> <br />L LOCATION OF INSTALLATION <br /> <br />] P~RMrrs ARE NON-TRANSFERABLE AHD EXPIRE IF WORK IS NOT ] <br /> I <br /> I <br />STARTED wrrlflN 180 DAYS OF ISSUANCE OR IF <br />WORK IS SUSPI~IDED FOR 180 DAYS. <br /> <br />2A. COHTRACTOR INSTALLATION OHLY <br /> <br /> FOR OWH1H[ INSTALLATIONS <br />Propmy Owner (olea~ print) <br /> <br />Mailing Addrms [ Phone <br /> <br />CitylStatefZip <br /> <br />Owner's Sisnau~: <br /> <br />Ag~nt'a Signature: <br /> <br />3. PLANRBVlBW 8BCTION <br /> <br />4. FEE ~CHEDUI~ (Complet~ and enter ~ot~l in A1 below) <br /> <br /> RESIDENTIAL [~ COMMERCIAL <br />USE OF STRUCTURE: <br />NEW ID ALTERATION ID ADDITION ID RIR~)CATION ID <br /> <br />GAS ID or ELECTRIC ID <br /> <br /> No. X P~ ~ 8urn <br />BABE FEE $10.00 <br /> <br />FORCED AIR FURNACE <br />upto IOO, OOO BTU $ 6.00 <br />over IOO,OOO BTU $ 7.00 <br /> <br />Floor Furnace $ 6.00 <br />Smpended Heater $ 6.00 <br />Wall Heater $ 6.00 <br />Floor Mounted Hea~er $ 6.00 <br /> <br />HEAT PUMP <br /> under 3 Ton <br /> 3 Ton and up <br /> <br />AIR CONDITIONER <br /> un6er 3 Ton <br /> 3 Ton and up <br /> <br />EvaporativeCooler <br />Commercial Exhamt System <br />Conunercial Hood and Exhamt <br />Domestic Rango Hood <br />Domestic Exhaust Fern <br /> and Dryer Vents <br /> <br />Wood Stovc/Fkeplac~ <br />Furmcc Ducts (Altcration/Extemion) <br />Comn~rcial / Industrial lncincrator <br /> <br />ADDmONAL APPLIANCES <br /> Gm Waler Healer <br /> Gm Log Lighter <br /> G-- Barbeque <br /> OIher <br /> <br />GA8 PIPING SYSTEM <br /> 1-4 ouUm (per ouUet) <br /> 4 and up outlets (p~ outlzt) <br /> <br />Appliance Vema not included in <br />an appliance pcFmit <br /> <br />OTHER (~m <br /> <br />DWEId,ING I~RMIT LABEL I of Lab~h <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°OO <br />$ 3.00 <br />$7.5O <br />$ 7.5O <br /> <br />$ 7.50 <br />$7.5O <br />$7.50 <br />$7.50 <br /> <br />$2.00 ~ <br />$ <br /> <br />$3.00 <br /> <br />N/C <br /> <br />IMarion 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. FRI~ Al. Ea~r total offo~ fiom S~. #4 <br /> A2. Add 5% surcharge (.05 x Al) <br /> <br />8ubto~! <br /> <br />B. Enter25% of linc Al for Plan Review <br /> (Al + .25), if required <br />C. Investigation Fez (if required) <br />D. Rcin.voo~n Fee ($25.OO) <br /> <br />TOTAL AMOUHT DUI[ <br /> <br />MC 15-41 R~ceipt No. <br />R~v. 12.~M <br /> <br /> <br />