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FOR CITY VALIDATION <br />Received by:. <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION .__ ~ ~--:~ ~ ~-~-~ ~,-~ F'~ <br /> COMMUNITY DEVELOPMENT CENTER .~.F~ [~:~i:~ ¥~' i~' ~ ~X~ <br /> 285 Church St NE' Room 132 ~'~'~ ~ ~ ~ ~] <br /> Salem, OR 97301 ~,¥ ~ <br /> ~ Hr In~t~n L~e: 58~7~ <br /> O~: 58~5147 8:~ a.m. - 4:30 p.m. ISSU~ by: ~A~I~ G0~'[Y <br /> F~: 588-79~ BUILDING INSPECTION <br /> <br />IMECHANICAL PERMIT APPLICATION <br />P/ease complete al~ Sections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />I~cdption/I~imctious <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. COHTRACTOR INSTALLATION ONLY / <br /> <br />Con~c~r'a License No. <br /> <br />Conlractor's Board Reg. :o. ~.. <br /> <br /> 2B. FOR OWNER INSTALLATIONS <br /> Proper~y Owner ~ lease print) <br /> Mailing Address Phone <br /> City/State/Zip <br /> Owner's Signature: <br /> Agent's Signature: <br /> <br />3. PLAN REVIEW SECTION <br /> <br />4. FEE SCHEDULE (Complete and enter ~olal in A 1 below) <br /> <br /> RESIDEHTIAL ~ COMMERCIAL [~ <br /> USE OF STRUCTURE: <br /> NEW,iii ALTERATION ~ ADDITION CI RELOCATION /2 <br /> GAS 1~' or ELECTRIC ~ <br /> No. X Fe~ =~ Sum' <br />BASE FEE $10.00 <br /> <br />FORCED AIR FURNACE <br />up lo 100,000 BTU $ 6.00 <br />over 100,000 BTU $ 7.00 <br /> <br />Floor Furnace $ 6.00 <br />Suspended ltealer $ 6.00 <br />Wall Heater $ 6.00 <br />Floor Mounled Healer $ 6.00 <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 $1 ID0 <br /> <br />EvsporaliveCooler <br />Commercial Exhaust System <br />Cmnmercial llood and Exhaust <br />Domestic Range Hood <br />Do~neslic Exhaust Fans <br /> and Dryer Vents <br />Fire Damper <br />Wood Stove/Fireplace <br />Furnnce Ducts (Allerntion/Extension) <br />Commercial / induslrial Incinerator <br /> <br />$4.50 <br />$4.50 <br />$4.50 <br />$4.50 <br /> <br />$ 3.00 <br />S 3.00 <br />$7.50 <br />$ 7.50 <br />$30.00 <br /> <br />ADDITIONAL APPLIANCE8 <br /> Gas Water Heater <br /> Gas Log Lighter <br /> Gas Barbeque <br /> O~her <br /> <br />$7.50 <br />$ 7.5O <br />$ 7.5O <br />$7.5O <br /> <br />OAS PIPING SYSTEM i-4 outlets (per outlet) <br /> 4 and up outlets (per outlet) <br /> <br />$ ZOO ~ <br />$ .50 ~ <br /> <br />Appliance Vents m~t included in <br />an appliance permit <br /> <br />$ 3.00 <br /> <br />OTHER (as requiced by 8ml~'~p, Ot~c'iaO <br /> <br />DWELLINO PERMFFLABEL #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 />MC 15-41 <br />Rev. 12/94 <br /> <br />5. FEES <br /> A I. Enter total of fees from Sec. #4 <br /> A2. Add 5% surcharge (.05 x Al) <br /> Subtotal <br /> <br /> B. Enter 25% of line A 1 for Plan Review <br /> (Al + .25), if required <br /> C. investigation Fee (ifrequired) <br /> D. Reinspection Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br /> Receipt No. __ <br /> <br />$~ <br /> <br /> <br />