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FOR CITY VALIDATION <br />Received by:. <br />Date: <br /> <br />MARION COUNTY BUILDING LNSPECTION ~-~ - <br /> <br /> 285 Church St NE · Room 132 I~lml-IMI/PIU: <br /> Salem, OR 97301 Date: <br /> <br /> 24 Hr Inspection Lin~: 588~7904 <br /> Office: 588-5147 8:OOa.m.-4:JOp.m. 18shed by: <br /> FAX: 558-7948 <br /> <br /> I <br />MECHANICAL PERMIT APPLICATION I <br />Please complete all Sections, I through 5 <br /> I <br /> <br />OCATION OF i~STALLATION <br /> <br />,xhA /D/O2 Amd--(z ME'- <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT <br /> STARTH} WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS, <br /> <br />2A. COHTRACTOR I~STALLATION OHLY <br /> <br /> 3. PLAN REVIEW SECTION <br /> <br /> Marion County does not require a plan review. <br /> We will provide plan review service if you complete <br />I Section 5B and submit two (2) sets of plans and <br />I specifications with this application. <br />lVK7 15-4 1 <br /> <br />4. FEIg SCHBDUL~ (Complete and entoe total in Al below) <br /> <br /> RESIDENTIAL [~1 COMMERCIAL [] <br /> USE OF STRUCTURE: <br /> NEW El ALTERATION 121 ADDITION 121 RELOCATION m <br /> GAS D or ELECTRIC 121 <br /> No. X Fe~ = Sum <br />BASE FEE $10.00 <br /> <br />FORCED AIR FURNACE <br />up to 100,000 BTU $ 6.00 -- <br />over 100,000 BTU $ 7.00 <br /> <br />FloorFumace $ 6.00 -- <br />Suspended Heater $ 6.00 -- <br />Wall Heater $ <br />Floor Mounte~l Heater $ 6.00 <br /> <br />HEAT PlfiVIP <br /> under 3 Ton <br /> 3 Ton a~d up <br /> <br />AIR CONDITIONER <br /> under 3 Ton <br /> 3 Ton and up <br /> <br />EvaporativeCooler <br />Commercial Exhaust System <br /> <br />and Dryer Vents $ 3.00 -- <br />Wood StovdFkeplae~ [ $ 7.50 ~ <br /> <br />Gas Water Heater i $7.50 '7f~ <br />GAS PIPING SYSTEM ~_ 4 .CO <br /> <br />$6.50 <br />$11.00 __ <br /> <br />$ 6.50 -- <br />SILO0 <br /> <br />$4.5O <br />$4.50 <br />$4.50 <br />$4.50 <br /> <br />Appliance Vent~ not included in <br />an appliance permit $ 3.00 -- <br /> <br />OTHER (ss wquired by Buil~ O~ciaD <br /> <br />DWELLING PERMIT LABEL # of Labels NIC <br /> <br />A 1. Enter total of fees from S~. #4 $ <br />A2. Add 5% surcharge (.05 x Al) $.__ <br /> Subtotal $.~ <br /> <br />B. Enter 25% of linc Al for Plan Review <br />(Al + .25), if required $ <br />C. Investigation Fee (if required) $.__ <br />D. Reinspeetion Fee ($25.00) $___ <br /> <br /> TOTAL AMOUNT DUE <br />Receipt No. <br /> <br /> <br />