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285 Church St NE · Room 132 r=nnm, ,~ o. · <br />-FOR CITY VALIDATION <br /> 71111 <br /> Salem, OR 97301 s, <br />Received by: Dales,. ~/A~/,~. <br />ID.`.': I . <br /> Office: 588-5147 8:00a.m.-4:30p.m. 18$U~O Dy: <br /> FAX: 5~8-7948 ' <br /> <br /> MECHANICAL PERMIT APPLICATION <br /> Please complete all Sections, I through 5 <br /> <br />1. LOCATION OF <br /> <br />/ <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT <br /> STARIT:~D WITHIN 180 DAYS OF 1SSUAHCE OR IF <br /> WORK IS SUSPENDI~ FOR 180 DAYS. <br /> <br />2A. CONTRACTOR ]I~STALLATION ONLY <br /> <br />Contracto£'s LW~nse No. <br /> <br />Board Reg. No. ~No. <br /> <br />2B. FOR OWNBR INSTALLATIONS <br />Proper~y Owner (please print) <br />Mailing Address Phone <br />City/Slate/Zip <br /> <br />Agent's Signature: <br /> <br />3. PLANREVlEW SECTION <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. FBB SCHBDULB (Complete and enter total in A1 below) <br /> <br /> RESIDENTIAL [~ COMMERCIAL 7'1 <br /> USE OF STRUCTURE: <br /> NEW E] ALTERATION n ADDITION ~ RELOCATION <br /> <br /> GAS 0 or ELECTRIC Jlff <br /> No. X F~ ,~'8~m'~l <br />BASE FEE <br /> <br />PORCED AIR FURNACE <br />up~ I~,~B~ $ 6.~ ~ <br />ov~ 1~,~ B~ $ 7~ <br /> <br />~rP~a~ $ 6.~ ~ <br />S~nded H~ler $ 6.~ ~ <br />Wall H~tor $ 6.~ ~ <br />~r Mo~d H~ter $ 6.~ ~ <br /> <br />HEAT PUMP <br /> under 3 Ton <br /> 3 Ton and up <br /> <br />AIR CONDITIOHBR <br /> under 3 Ton <br /> 3 Ton anti up <br /> <br />EvaporativeCoolor <br />C~mmereial Exhaust System <br />Commercial Hood and Exhaust <br /> <br />$ 6.50 <br /> <br />$ 6.50 <br />$11.00 -- <br /> <br />$ 4.50 <br />$4.50 -- <br />$ 4.50 -- <br />$ 4.50 <br /> <br />$ 3.00 <br />$ 7.50 -- <br />$7.5O -- <br />$30.00 -- <br /> <br />ADDITIONAL APPLIANCES <br /> Oas Water Healer <br /> Oa~ Log Lighler <br /> Gas Barbeque <br /> O~ber <br /> <br />$7.50 -- <br />$7.50 -- <br />$7.50 -- <br />$7.50 -- <br /> <br />OAS PIPING SYSTEM <br /> 1-4 outlets (per outlet) <br /> 4 and up outlets (per outlet) <br /> <br />$ 2.00 <br />$ .50 -- <br /> <br />$ 3.00 -- <br /> <br />N/C <br /> <br />5. FBB$ <br /> Al. Enter total of fees from Sec./34 <br /> A2. Add 5% surcharge (.05 x Al) <br /> ~ubtotal <br /> <br /> B. Enler 25% of line Al for Plan R~view <br /> (Al + .25), if required <br /> C. Investigation Fee (if required) <br /> D. Reinspection Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br /> Receipt No. <br /> <br /> <br />