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FOR CITY VALIDATION [ <br />Received by:. <br />Dat~: <br /> <br /> MECHANICAL PERMIT APPLICATION <br /> Please complete all Sections, I through 5 <br /> <br />l. LOCATION OF INSTALLATION <br /> <br /> A ql3q LO, 'kmx' r, <br />Desotiption/Ddingtions <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUN 1TY DEVELOPMENT CENTER <br /> 285 Church St NE · Room 132 ~"' <br /> Salem, OR 97301 J!" ~.,. ~Jl/I <br /> Dnte: ~ <br /> 24 Hr lnq~ection Ling 588-7904. <br /> Off.ge: 588-5147 $:00a.m.-4:30p.m. [~USd <br /> FAX: 588-7948 "*' m~P£OTloi <br /> <br /> 4. lqgR 5CH~DLI-L~ (Complete ami enter total in A 1 bdow) <br /> <br /> USE OF STRUCTURE: <br /> NEW ~1 ALTERATION n ADDITION <br /> GAS Cl or ELECTRIC ~1 <br /> No. X Fee = Sum <br /> BA~E FEE $10.00 <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT <br /> STARTle) W1THIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPEI~DED FOR 150 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br /> 2B. FOR OWNER INSTALLATION8 <br /> Pmp~y Owner (ple,~se pri~) <br /> Mailing Address Phone <br /> City/Sm~ip <br /> Owner's Signature: <br /> Agent's Signature: <br /> <br /> 3. PLANRBVIBW 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 />MC 15-41 <br /> <br />FORCED AIR FURNACE <br />np o ioo,ooo $ 6.00 <br />over 100,000 BTU $ 7.00 <br /> <br />Floor Furnace $ 6.00 <br />Suspended Heater $ 6.00 <br />Wall Heater $ 6.00 <br />Floor Mounted He. agr -- $ 6.00 <br /> <br />HEAT PUbIP <br />un&r 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 />EvaporativeCooler $ 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 Di'y er Vents $ 3.00 <br />Fir~ Damper $ 3.00 <br />Wood Stove/Figplace $ 7.50 <br />Furnace Duc~s (Alt ~ation/Ext ensio n) $ 7.50 <br />Commercial / lnd~trial Incinerator $30.00 <br /> <br />ADDITIONAL APPLIANCE8 <br />Gas Water Hea~er $ 7.50 <br />Gas Log Lighter $ 7.50 <br />Gas Bad~qt~ $ 7.50 <br />O~he~ $ 7.50 <br /> <br />GAS PIPING SYSTEM <br />1-4 outlets (per outlet) ~ $ 2.00 <br />4 and up outlels (per ~tlet) $ .50 <br /> <br />Appliance Venls not included in <br />an appliance permit <br /> <br />OTHER (as reqinrcd by Bt~l~g OfdciaO <br /> <br />DWELLING PERMIT LABEL # of Labels <br /> <br />$ 3.00 <br /> <br />Al, Enl~r tolnlof fees from S~c. fi4 <br />A2. Add 5% surcharge (.05 x Al) <br /> <br />~bt~.al <br /> <br />B. Enter 25% of lin= A1 for Plan Review <br />(A 1 + .2.5), if r~quired $ <br />C. Investigation Fe~ (if ~quired) $ <br />D. Reimpection Fee ($25.00) $ <br /> TOTAL AMOUNT DUE $/~.~ <br />Receipt No. ---- <br /> <br />k <br /> <br /> <br />