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FOR CITYVALIDATION[ <br />Received by: <br />Date: <br /> <br />MARION COUNTY BUILDING <br /> COMMUNITY DEVELOPMENT CENTER __~..~ <br /> 285 Church St NE- Room 132 <br /> Salem, OR 97301 Date J <br /> 24Hr Inspection Line: 588-7904 <br /> Off.ace: 588-5147 8:00a.m.-4:30p.m. ]$$UOd~lJkl~ I~tonr- ..... <br /> FAX: 588-7948 <br /> <br />MECHANICAL PERMIT APPLICATION <br />Please complete ali ~ections, I through 5 <br /> <br />I.,LOCATION OF INSTALLATION <br /> <br />Job Addre~~ <br /> <br />~ Aumsville c.~s~ Main <br />P,o~yow,~ M. Ven~m~n Ph~¢ 749-1 352 <br /> <br />D~¢a0a~n~tiona 2.5 ton heat pump add-on <br /> <br />PERMITS ARE NON-TRANSFERABLE AND F~XFIRE IF WORK IS NOT <br /> STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS, <br /> <br />23u CONTRACTOR INSTALLATION ONLY <br />Ore~n~r°n Heating & Coolint Phone581-8747 <br />Maili~Aa4r~. 2365 Front St NE,Salem 97303 <br /> <br />Contractor's License No. <br /> <br />k <br /> <br />4. FEE SCHEDULE (Complete and enter total in A1 below) <br /> <br /> ~smE~rrIAL7~ ~ co~M~ac~ D <br /> owe~lng <br /> USE OF STRUCT~: <br /> NEW D ~ATION D ~D~ION ~ ~CATION ~ <br /> GAS ~ or ELEC~I~ <br /> N~ X F~ = Sum <br />BASE FEE $10~ <br /> <br />FORCED AIR FURNACE <br /> up to 100,000 BTU <br /> over I00,000 BTU <br /> <br />Floor Furnace <br />Suspended Heater <br />Wall Heater <br />Floor Mounted Heater <br /> <br />HEAT PUMP <br /> under 3 Ton <br /> 3 Ton and up <br /> <br />AIR CONDITIONER <br /> under 3 Ton <br /> 3 Ton and up <br /> <br />EvaporativeCcoler <br />Commercial Exhaust System <br />Commercial Hood and Exhaust <br />Domestic Range Hood <br />Domestic Exhaust Fans <br /> <br /> Fire Damper <br />Contraetor'sBoardReu. No. 786~L0--_.~[ JoiCo. I I W°°dSt°v~a:ireplace <br /> - /'- - -'~- 1/ ,'D I I Furnace Ducts (Alteration/Extension) <br />Contr~/~~...~ Commercial/lnduslfial Incinerator <br /> <br />2,B. FOR OWNER INSTALLATIONS <br /> <br />Property Owner (pleaseprim) <br /> <br />Mailing Addreza Phone <br /> <br />$ 6.00 -- <br />$ ZOO -- <br /> <br />GAS PIPING sYSrEM <br /> 14 outlets (per oudc0 <br /> 4 and up outlets (per outlet) <br /> <br />Appliance Vents not included in <br />an appliance permit <br /> <br />OTHER (as required by Building Of~uia0 <br /> <br />DWELLING PERMIT LABEL # of Labels <br /> <br /> CRy/State/Zip <br /> Owner's Signature: <br /> Agent's Signature: <br /> <br /> 3. PLANRHVIEW 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 />MC 15.41 <br />Rev. 12/94 <br /> <br />$ 6,O0 -- <br />S 6,00 __ <br />$ 6,00 <br />$ 6.00 __ <br /> <br />1 $ 6.50 6.50 <br /> $11.00 -- <br /> <br />$ 6.50 -- <br />$11.00 <br /> <br />$ 4.50 <br />$ 4.50 <br />$ 4.50 <br />$ 4.50 <br /> <br />$ 3.00 -- <br />$ 3.00 <br />$ 7.50 <br />$ 7.50 <br /> $30.o0 __ <br /> <br />$ 7.50 <br />$7.50 <br />$7.50 <br />$7.50 <br /> <br />$ 2.00 <br />$ .5o __ <br /> <br />$ 3.00 <br /> <br />Nlq <br /> <br />5. FEES <br /> A 1. Enter total of fees from Sec.//4 <br /> A2. Add 5% surcharge (.05 x Al) <br /> <br />~btotnl <br /> <br />B. Enter 25% of lineAl for Plan Review <br /> (Al + .25), if required <br />C. Investigation Fee (if required) <br />D. Reinspection Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br />Rc~ceipt No. <br /> <br />16.50 <br /> .83 <br /> <br /> <br />