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FOR CITY VALIDATION <br />Received by:. <br />Date: <br /> <br />COMMUNITY DEVELOPMENT CENTER PER <br />285 Church St NE ' Room 132 ~ ~,~ <br />Salem, OR 97301 Date: <br /> ., MARION COUNTY <br /> <br />24 Hr Inspection Line: 588-7904 <br />Off'~.o: 588-5147 8:00a.m.-4:30p.m. <br />FAX: 588-7948 <br /> I <br /> <br /> MECHANICAL PERMff APPLICATION <br /> Please complete all ~.eections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT <br /> STARTED WrlTHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK 15 SUSPENDED FOR 180 DAYS. <br /> <br />Job No. <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br />Agent's Signature: <br /> <br />4. FEE SCH]~[DUL~ (Comple~ and ante~ miniinA1 bdow) <br /> RESIDENTIAL ~ <br /> <br /> USE OF STRUCTURE: <br /> NEW D ALTERATION ADDITION r3 RELOCATION <br /> GAS~ or ELECTRIC ~ <br /> No. X Foe = Sam <br />BAfiE FEE S10.~0 <br /> <br />FORCED AIR FURNACE <br />up to 100,000 BTU $ 6.00 -- <br /> over 100,000 BTU $ 7.00 -- <br /> <br />FIoorFumace $ 6.00 -- <br />Suspended Heater $ 6.00 -- <br />Wall Heater ~ $ 6.00 <br />Floor Mounted Heater ~ <br /> $ <br /> 6.00 <br /> <br />HEAT pUMP <br />under 3 Ton $ 6.50 <br />3 Ton and up $11.00 <br /> <br />AIR CONDITIONER <br />under 3 Ton $ 6.50 <br />3 Ton and up $11.00 -- <br /> <br />EYapotntiveCooler $ 4.50 <br />Commercial Exhauat System $ 4.50 -- <br />Commemia! Hood and Exhaust $ 4.50 <br />Domestic Range Hood $ 4.50 -- <br /> <br />and Dryer Vents $ 3.00 -- <br />Fir~ Damper $ 3.00 -- <br />Wood Stove/F~replaee $ 7,50 -- <br />Furnace Duels (Aiterntion/Ext~msion) $ 7.50 -- <br />Commercial / Industrial Incinerator $30.00 -- <br /> <br />ADDmONAL APPLIANCES <br />Gas Water Heater ~ $ 7.50 -- <br />Gaa Log Lighter $ 7.50 <br />Gas Badmque $ 7.50 -- <br />Other $ 7.50 <br /> <br />GAS PIPING SY$TEM <br />1~ outle~ (peroullnt) ~. $ 2.00 -- <br />4 and up outlets (per outlet) $ ,50 -- <br /> <br />Appliance Vcnt~ not included in <br />an appliance gennit $ 3.00 -- <br /> <br />OTHER Os requir~d by Buil~t~ Ol~ci~l) <br /> <br />DWELLING PERMIT LABEL # of Labels <br /> <br />N/C <br /> <br />3. PLAN REVIEW SECTION <br /> <br />IMarion 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 />ME' I541 <br />Rev. 12/94 <br /> <br />5. FLEES <br /> Al. Enter total of fees fiom Sec. #4 <br /> A2. Add 5% surcharge (.05 x A I) <br /> <br />B. Enter 25% of lineAl for PlanReview <br />(Al + .25), if required $__ <br />C. Investigation Fcc (if required) $__ <br />D. Reinspection Fee ($'25.00) $__ <br /> <br /> TOTAL AMOUNT DUE <br />Receipt No. <br /> <br /> <br />