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FOR CITY VALIDATION <br />Re~eivedby:, <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTIO~ ~,~''~ <br /> COMMUNITY DEVELOPMENT CENTER __Lt~..._ ~_~..~ <br /> 285 Church St NE' Room 132 <br /> Salem, OR 97301 <br /> <br /> issued BoUy!LDING INSPECTION <br /> <br />24 Hr Inspection Line: 588-7904 <br />Office: 588-5147 8:00aan.- 4:30 pan. <br />FAX: 588-7948 <br /> I <br /> <br />MECHANICAL PERMIT APPLICATION <br />Please complete all Sections, I through $ <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />Pt~eay Owner ~ ] Phone <br />I:~cfiptio~/Ddi~¢~m <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXPIRE 1F WORK IS NOT <br /> STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPEHDED FOR 180 DAYS. <br /> <br />2A. COiWFRACTOR INSTALLATION ONLY <br /> <br />Contractor's License No. <br /> <br />Contractor's Board Reg, No. /g¢~O~[l~ Job No.~. ~'~ ~ <br /> <br />2B. FOR OWNER INSTALLATIONS ~ <br /> <br />Property Owner (plea~p~qnt) <br />Mailing Address Phone <br />Clly/S tate~Z'lp <br /> <br />Agent's Sigmture: <br /> <br />3. PLANREVIEW SBCTION <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 />4. FEE SCHEDULE (Comple~ and entar total in Al below) <br /> <br /> RESIDF-,HTIAL ~[~ COMMERCIAL {~ <br /> USE OF STRUCTURE: <br /> NEW {2 ALTERATION ~/~ADDITION O RELOCATION m <br /> <br /> GAS ~ or ELECTRIC <br /> <br />}~F~oASE FEE <br /> RCED AIR FURNACE <br /> up to 100,000 BTU <br /> over 100,000 BTU <br /> <br /> Suapended Heat=r <br /> Wall Heater <br /> Floor Mounted Heater <br /> <br />$10.~0 <br /> <br />HEAT PUMP <br /> under 3 Ton <br /> 3 Ton and up <br /> <br />AIR CONDITIONER <br /> under 3 Ton <br /> 3 Ton and up <br /> <br />EvaForativ~C~oler <br />Commercial Exhaust System <br />Commercial Hood and Exhaust <br />Domeatic Range Hood <br />Domestic Exhau~ Fans <br /> and Dryer Veins <br />Fir~ Damper <br />Wood Stove/Fireplace <br />Furnace Ducts (A It er nt/on/Extonsion) <br />Commercial / lndu~ial Incinerator <br /> <br />OAS PIPINO SYSTEM <br /> 1~ outlets (p~r outle0 <br /> 4 and up outlets (pot oulle0 <br /> <br />Appliance Vents not included in <br />an appliance permit <br /> <br />OTHER (as cequited by B~ild~t~ O~eial) <br /> <br />DWELLING PERMIT LABEL # of Labols <br /> <br />$ 6.00 <br />$ 7.00 <br /> <br />$ 6.00 <br />$ 6.00 <br />$ 6.O0 <br />$ 6.OO <br /> <br />$ 6.50 <br />$11.00 -- <br /> <br />$ 6.50 <br />$i].oo __ <br /> <br />$ 4.50 <br />$4.50 <br />$4.50 <br />$4.50 <br /> <br />8 3,00 <br />8 3.00 <br />$7.50 <br />$ 7.5O <br />$3O.OO -- <br /> <br />$7.50 <br />$ 7.50 <br />$ 7.50 <br />$ 7.5O <br /> <br />$ 3.00 -- <br /> <br />NIC <br /> <br />5, FEES <br /> A 1. Enter total of f~ from S~c. #4 <br /> A2. Add 555 surcharg~ (.05 x Al) <br /> 8ubt~al <br /> <br /> B. Enter25% of lineal for Plan R~viow <br /> (Al + .25), if roquir~d <br /> C. Investigation Fee (if required) <br /> D. R¢inspection Fee ($25.00) <br /> <br /> TOTAL AMOUHT DUB <br /> Receipt No. <br /> <br />8 '~7, Od <br /> <br />8 <br /> <br /> <br />