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FOR CITY VALIDATION <br />Receivedby:. <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER PERMIT NO: <br /> 285 Church St NE * Room 132 <br /> Salem, OR 97301 <br /> Date: <br /> <br />24 Hr Inspection Lin~. 588-7904 <br />Off'mo: 588-514/ 8:00a.m.-4:30p.m. <br />FAX: 588=7948 <br /> <br />Issued by: <br /> <br /> MECHANICAL PERMIT APPLICATION <br /> Please complete all Sections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />De~cfiption/Ddit~cfions <br /> <br />PI/RMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT <br /> STARTED WITHIN I~0 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br />Pwpe~ly Owner (pleasepr~t) <br /> <br />City/S~a~/zip <br /> <br />Owner's Signatu~: <br /> <br />A~nt's Signature; <br /> <br />4. FEB SCH~DUL~ (Complete and ente~ ~t~l ~ A1 below) <br /> <br /> RESiDE~I~ ~ COMMERCI~ ~ <br /> USE OF ~RU~E: <br /> HEW ~ ~TION ~ ~DffION~OCA~ON ~ <br /> GAS ~' or ~EC~IC~ <br /> <br />B~ FEE $10.~ <br /> <br />FORCED AIR FURNACE <br />up to 100,000 BTU ~ $ 6.00 -- <br />over 100,000 BTU $ 7.00 <br /> <br />FloorFumace $ 6.00 -- <br />Susl~nded Heater $ 6.00 <br />Wall Heater $ 6.00 -- <br />Floor Mounted Heater $ 6.00 -- <br /> <br />HEAT PUMP <br />under 3 Ton $ 6.50 <br />3 Ton and up $11.00 -- <br /> <br />AIR cOIqDITIONI~R <br />under 3 Ton ~ $ 6.50 -- <br />3 Tonand up $11.00 <br /> <br />Evaporativeeooler $ 4.50 <br /> <br /> and D~er Vant$ ~- $ 3.00 <br />Wood Stove/F~j~iac~ .--- ~ $ 7.50 <br /> <br /> 1-4 outlets (per outlet) / $ 2.00 <br /> <br />ADDITIONAL APPLIANCES <br /> G$a Water Heater <br /> G~a Log Lighter <br /> Ga~ Barb~lu~ <br /> Oth0r <br /> <br />$7.50 -- <br />$ 7.50 -- <br />$7.50 -- <br /> <br />OTHER (as reqoirod by B~ldh~g OF~eial) <br /> <br />DWELLINO PERMIT LABBL # of Labels <br /> <br />N/C <br /> <br />3. PLAN RBVIBW 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 />I specifications with this application. <br /> <br />lVlC 15-41 <br /> <br />5. FItES Al. Enter total of fees from Sec. #4 <br /> A2. Add 5% sumharge (.05 x Al) <br /> <br />Subtotal <br /> <br />B. Enter 25% of lint A1 for Plan Review <br />(Al + .25), if required $__ <br />C. Inv=stigation Fee (if required) <br />D. Reinspection Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUE $ <br />Receipt No. <br /> <br /> <br />