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FOR CITY VALIDATIOH <br />Rec~i~ed by: <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> 28:5 Church St NE · Room 132 [:~RMiT NO: <br /> Salem, OR 97301 <br /> <br />24 Hr Inspection Lin~ 588-7904 <br />Office: 588-514'7 8:00 a.m. - 4:30 p.m. <br />FAX: 588-7948 <br /> <br />MECHANICAL PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT <br /> STAR'i~ WITHIN 1~0 DAYS OF ISSUANCE OR IF <br /> WORK 1S SUSPEND~ FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION OHLY <br /> <br />Conwactor JuDSON' S, INC. Phone 363-4141 <br /> PO BOX 12669 SALEM OR 97309 <br />Mailing Addre~ <br /> <br />Contractor's License No. 24-22PB <br /> <br /> 34604 <br />Contractor's Board Reg.. No. ,~°b No. <br />Contractor's Signature: e,~"~_.....~7~ <br /> <br />2B. FOR OWHER INSTALLATIONS <br /> <br />Owner's Signature: <br /> <br />Agent's Signature: <br /> <br />3. PLANRBVIRW SECTION <br /> <br />Date: <br /> <br />Issued by: <br /> <br />4. FEE SCHEDUI~ (Complete and enter total in Al below) <br /> <br /> " RESIDENTIAL [] COMMERCIAL [] <br /> USE OF STRUCTURE: <br /> NEW O ALTERATION Q ADDITION ~1RELOCA~Oj~I~-.,, <br /> GAS ~ or ELECTRIC O <br /> No. X · Pe~ ~Sum <br />BASE FEE ~ <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.O0 ~ <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 $ 4.50 <br />Commercial Exhaust System ~ $ 4.50 <br />Commercial Hood and Exhaust $ 4.50 <br />Domestic Range Hood $ 4.50 <br />Domestic Ex~uat Fans <br />and Dryer Vents $ 3.00 <br />Fir~ Damper $ 3.00 <br />Wood StoveTFirep~ce $ 7.~0 <br />Fun',~ce Ducts (AlteratioutExt~.~ion) $ 7.50 <br />Commercial I Industrial Incinerator $30.00 <br /> <br />ADDITIONAL APPLIANCES <br />Gas Water Heater $ 7.50 <br />Gas Log Lighter $ 7.50 <br />Gas Barbeqne $ 7.50 <br />Other $ 7.5O <br /> <br /> _ / <br />GAS PIPING SYSTEM ~ <br />1-4 outlels (per outlet) ~" $ 2.00 <br />4 and up outlets (per outlet) $ .50 __ <br /> <br />Appliance Vents not included in <br />an appliance permit $ 3.00 <br /> <br />OTHER (as required by Buiidiog Olt~¢ia0 <br /> <br />DWELLING PERMIT LABEL # of Labels <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 />FEES <br />Al. Enter total of fees from Sm. #4 <br />A2. Add 5% surcharge 605 x Al) <br /> <br />Subtotal <br /> <br />B. Enter 25% of line A 1 for Plan Review <br /> (A 1 + .25), if required <br />C. Investigation Fee (if required) <br />D. Reimpection Fee ($25.00) <br /> <br />TOTAL AMOUNT DUE <br /> <br />MC 15-41 Receipt No. <br /> <br /> <br />