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FOR CITY VALIDATION [ <br />Received by: <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTI <br /> COMMUNITY DEVELOPMENT CENTER <br /> 285 Church St NE - Room 132 <br /> Salem, OR 97301 <br /> <br /> 24 Hr Inq~ctlon Line: 588-7904 ISSU odM}~R~ <br /> Office: 588-5147 8:00 a.m. - 4:30p.m. -- <br /> FAX: 5SS-TV4S BUILDING INSPECTION <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 /> STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPI~qDED FOR 180 DAYS. <br /> <br />2A. COHTRACTOR INSTALLATION ONLY <br /> <br />Contractor'$ Li~ense No. ~'~L~O% 0 <br />Co.ts~tor'. ~,,~d R,,~. No. ~Tq ~o~ No. <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br />Pmge~ Owner (ple~ print) <br /> <br />Mailing Address <br /> <br />City/StatedZip <br /> <br />Ow~r's Signntm-e: <br /> <br />4. F~E SCHEDULE (Complete and ente~ total in Al below) <br /> <br /> ~D~I~ ~ COMMERC~ ~ <br /> USE OF ~UCT~E: <br /> NEW ~ ~RATION ~ ~D~ON ~ ~OCATION ~ <br /> GAS ~ or ~EC~IC ~ <br /> <br />B~ F~ <br /> <br />FORCED AIR FURNACE <br />up~o ~oo,ooo ~TU --L- s 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 Mountud Heater $ 6.00 <br /> <br />HEAT PUMP <br />under 3 Ton $ 6.50 <br />3 Ton and up $11.00 <br /> <br />AIR CoNDmONER <br />under 3 Ton $ 6,50 <br />3 Ton and up $11,00 <br /> <br />Evaporative, Cooler $ 4.50 <br />Commercial Exhaust Syslem $ 4.50 <br />Commercial Hood and Exhaust $ 4.50 <br />Domestic Range Hood $ 4.50 <br />Domestic Exhaust Fans <br />a~d Dryer Vents $ 3.00 <br />Firg Damper $ 3.00 <br />Wood Stov~iFireplace $ 7.50 <br />Furnace Ducts (Alto'alioWExt ~nsion) $ ?.50 <br />Commcmial / hldush-ial Incinerator $30.00 <br /> <br />A~orpiONAL APP,.lANCeS <br />Oas Waler Heater $ 7.50 -- <br />Gns Log Lighter $ 7.50 -- <br />Gas Bad,q, ue $ 7.50 -- <br />Other $ 7.50 <br /> <br />GAS PIPING SYh'I~M <br /> 1-4 outleta (per ouOe0 <br /> 4 and up outlets (per out[et) <br /> <br />Appliance Vents not included in <br />an appliance permit <br /> <br />OTHER (as required by Built~t~g Ol~cial) <br /> <br />DWELLING PERMIT LABEL # of Labels <br /> <br />$ 2.00 -- <br />$ 30__ <br /> <br />$ 3.00 -- <br /> <br />3. PLANREVIEW SBCTION <br /> <br /> Marion County does not require a plan review. <br />I <br />We will provide plan review service if you complete <br />I Section 5B and submit two (2) sets of plans and <br />specifications with this application. <br /> <br />MC 15-41 <br /> ~v. 12/94 <br /> <br />5. FEES <br /> Al. Enter total of fe~s from Sec. #4 <br /> A2. Add 5% surcharge (.05 x Al) <br /> 8ubtmal <br /> <br /> B. Ealer 25% of line Al for plan Review <br /> (Al + .25), if r~quired $ <br /> C. Investigation Fee (if required) $ <br /> D. Rcinspeetion Foe ($25.00) $ <br /> TOTAL AMOUNT DUE sJ~ <br /> Receipt No. <br /> <br /> <br />