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FOR CITY VALIDATION [ <br />Received by: <br />Date: <br /> <br /> Salem, OR 97301 <br /> <br />24 Hr In~p~tion LinG: 588-7904 <br />Off'~o: 588-5147 8:00a.m.-4:30p.m. <br />FAX: 588-7948 <br /> <br />MECHANICAL PERMIT APPLICATION <br />Please complete all Sections, I throUgh 5 <br /> <br />L LOCATION OF INSTALLATION <br /> <br />il <br /> <br />I~eRMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT I <br /> { <br /> STARTED V~qTH IN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />FOR OWNER INSTALLATIONS <br /> <br />l~openy Owner ~leaso print) <br /> <br />Mailing Address Phone <br /> <br /> v COUNT ,, <br /> <br />4. FEE SCH~ (C~plete ~d ent~ ~ul M Al be~w) <br /> ~SIDE~ ~ .COMMERCI~ ~ <br /> <br /> GAS ~ or E~C~IC O <br /> <br />BASE FEE $10.~ <br /> <br />FORCED AIR FURNACE <br />upto 100,000 BTU $ 6.00 <br />over 100,000 BTU / $ 7.00 <br />Floor Furnace $ 6.00 <br />Suspended Heater $ 6.00 <br />Wall Heater $ 6.00 <br />b3oor Mounted H~ $ 6.00 <br /> <br />HEAT PUMP <br />under 3 Ton $ 6.50 <br />5 Ton and up $1L00 <br /> <br />AIR CONDITIONER <br />under 3 Ton $ 6.50 <br />3 Ton and up $11.00 <br /> <br />EvaporativeC~oler $ 4.50 <br />Commercial Exhaust System $ 4.50 <br />Commercial Hood and Exhaust $ 4.50 <br />Domestic Range Hood $ 4.50 <br />Domestic Exhaust Fans <br />and D~yer Vents $ 3.00 <br />Fire Damper $ 3.00 <br />Wood Stove/Fireplace $ 7.50 <br />Furnace Ducts (Alteration/Extension) $ 7.50 <br />Commercial / Industrial Incinerator $30,00 <br /> <br />ADDITIONAL APPLIANCES <br />Gas Water Heater $ 7.50 <br />Gas Log Lighter $ 7.50 -- <br />Gas Batbeque $ 7.50 <br />Giber $ 7.50 -- <br /> <br />OAS PIPING SYSTEM <br /> 1-4 outl¢la (per outl0t) [ <br /> 4 and up outlets (per outlet) <br /> <br />Appliance Vents not included in <br />an appliance permit <br /> <br />OTHER (~s required by Bu~ldqg Ofdci~D <br /> <br />DWELLING PERMIT LABEL # of Labels <br /> <br />$ 2.00 <br />$ .50 __ <br /> <br />$ 3.00 __ <br /> <br />N/C <br /> <br /> 3. PLANREVIEW 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 />l~C I.5-41 <br /> <br />5. FEES <br /> A 1. Enter total of fees from Se, c./~4 <br /> A2. Add 5% surcharge (.05 x Al) <br /> Subtotal <br /> <br /> B. Enter 25% of line A 1 for Plan Review <br /> (Al + .25). if r0quired <br /> C. Investigation Fee (if reqinr~d) <br /> D. Rein~peetion Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br /> Receipt No. <br /> <br /> <br />