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FOR CITY VALIDATION] <br />Reoeived by:~ <br /> <br />MAR.ION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER ,',;~,l~'~c~ ~-I I ~ <br /> 285 Church St NE · Room 132 ............ <br /> Salem, OR 97301 Date: MARION COUNTY <br /> BUILDING INSPECTION <br />24 Hr Inepe~tion Line: 588-7904 <br />~ ndlr Off]~: 588-5147 8:00aah,-4:30p,m. Issued by: <br /> <br />MECHANICAL PERMIT APPLICATION ] <br />Please complete all Sections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />ARE NON-TRANSlq~RABLE AND EXPll~J~ IF WORK IS NOT, <br /> STARTED WITHIN 180 DAYS OF I$SUA.N .CE .OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. ' ' <br /> <br /> CONTRACTOR INSTALLATION ONLY <br />Phone <br /> <br />FOR OWHRR il~ISTALLATiON$ <br /> <br />Property Owner (please pri~) <br /> <br />Mailing Addre~a I Phone <br /> <br />City/State/Zip <br /> <br />Ownot's Signature: <br /> <br />Agent's Signature: <br /> <br />3. PLAN RttVIEW 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. File $CHEDD-L~ (Complete and entex total in A1 below) <br /> RESIDENTIAL~ COMMERCIAI~ <br /> USE .OF~TRUCTLrRE: <br /> NEW.-~ ALTERATION {~. ADDrrlON O RELOCATION <br /> GAS El or ELECTRIC'~ <br /> <br />BASE FEE $1aoo <br /> <br />FORCED AIR FWRNACE <br />up to 10O,00O BTU $ 6,00 <br />over 100,000 BTU $ 7,00 -- <br /> <br />Floor Furnace $ 6.00 -- <br />Suspended Heater S 6.00 <br />Wall Heater $ 6.00 -- <br />Floor Mounted H~ter S 6.00 -- <br /> <br />H~AT pLRdP <br /> under 3 Ton <br /> 3 Ton and up <br /> <br />AIR CONDITIONER <br /> under 3 Ton <br /> 3 Ton and up <br /> <br />EvaporativeCooler <br />Commercial Exhau~ Sys~m <br />Comraercial Hood and Exhaust <br />Domestic Range Hood <br />Domeslic Exhaust Fana <br /> and D~/er Vonts <br />Fir~ Damper <br />Wood Stove/Fireplace <br />Furnace Ducts (Alteration/Extension) <br />Commercial ! Industrial Incinerator <br /> <br />$ 6.50 <br />$11.00 <br /> <br />$ 6.50 <br />$ I 1,0O <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 />$30.00 <br /> <br />ADDITIONAL APPLIANCES <br /> <br /> Gas L~g Lightex <br /> Gas gadoequ~ - <br /> Other <br /> <br />$ 7.50 <br />$ 7.50 <br />$ 7,50 <br />$7.50 <br /> <br />GAS PIPING 8YfffEM <br /> 14 outlets (per outlet) <br /> 4 and up outlets (per outlet) <br /> <br />Appliance Vents not included in <br />~ appli~ce pe~it <br /> <br />OTHER (as mq~d by B~I$~ O~ciM) <br /> <br />DWELLING ~ L~EL ~ of ~h <br /> <br />$ 2.00 <br />$ .50 <br /> <br />$ 3.00 <br /> <br />N/C <br /> <br />5. FF~S <br /> A I. Enter total of fees imm Sec. ~M' <br /> A2. Add 5% surcharge (.05 x A 1) <br /> ~bt~al <br /> <br /> B. ~r25% oflM~Al forP~vi~w <br /> (A I + ,25), if mqu~d <br /> C. Investigation F~ (ifmqui~d) <br /> D. Rei~peel~n Fee ($25.~) <br /> <br /> · <br /> Receipt No. <br /> <br /> <br />