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FOR CITY VALIDATION[ <br />Received by: [ <br />Date: I <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 Indict/on Lh~e: 588-7904 <br />Off.me: 588-5147 B:00a.m.-4:30p.m. <br />FAX: 588-7948 <br /> <br />Issued by: <br /> <br />MECHANICAL PERMIT APPLICATION <br />Please completo all Sections, I through 5 <br /> <br />L LOCATION OF INSTALLATION <br /> <br />pERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT <br /> STARTED WITHIN 1~0 DAYS OF ISSUANCE OR IF <br /> WORK IS SU/IFENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />M.ili"sAda~.~0~,agt2g~9 ~ ~ 973~9 <br /> <br />2B. FOR OV/NBR INSTALLATIONS <br /> <br />Properly Owner (pleas~pri~t) <br />Mailing Addre~ Phone <br />City/State/Zip <br /> <br />Agent's Signature: <br /> <br /> F]~E SCH~DUL~ (Complato and ont~ total in A1 below) <br /> <br /> ~IDE~I~ ~ COMMERCI~ ~ <br /> USE OF ~RU~: <br /> NEW Q AL~RATION ~ ~D~ION Q ~ATION ~ <br /> GAS O or ELE~IC ~ <br /> <br />B~ FEE $10.m <br /> <br />FORCED AIR FURNACE <br />up to 100,~0 BTU $ 6.00 __ <br />over 100,000 BTU $ 7.00 <br /> <br />lqoorFumaee $ 6.00 -- <br />Suspended Heater $ 6.00 -- <br />Wall E~ater $ 6.00 -- <br />Floor Mounted Heater $ 6.00 <br /> <br />HEAT pUMp <br />under 3 Ton $ 6.50 <br />3Ton and up ~' SILO0 <br /> <br />AIR CONDITIONER <br />under 3 Ton $ 6.50 <br />3 Ton and up $ l t .00 <br /> <br />EvapomtiveCooler $ 4.~0 <br />Commercial Exhaust Syst~n $ 4.50 <br />Commercial Hood and Exhaust $ 4,~0 <br />Domestic Range Hood $ 4.50 <br />Domestic Exhaust Fans <br />and Dry~ V~nts $ $.00 <br />Fire Damper $ 3.00 <br />Wood StovedFirepla;e $ 7.50 <br />Furnace Ducts (Alteration/Extension) $ 7,50 <br />Commercial / Induatrinl Incinerator $30,(30 <br /> <br />Other $ 7.50 <br /> <br />GAS PIPING sYgrBM <br /> 14 outlets (per outlet) <br /> 4 snd up oullels (per ~flat) <br /> <br />O~ER (a~ ~qui~d by Buil~ O~ciaI) <br /> <br />DWELLIHG PE~ L~EL ~ of ~ls <br /> <br />$ 2.00 <br />$ .5o __ <br /> <br />$ 3.00 <br /> <br />NIC <br /> <br /> 3. PLAN REVIEW SECTION <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 />MC 1541 <br />Posy. 12/~ <br /> <br />5. Fr~s <br />A 1. Enter total of fees from S~e. #4 $~_~_ <br />A2. Add5%sureharge(.05xA1) $ j, <br /> Subtotal $.,~ <br /> <br /> B, Enter 25% of line Al for Phm Review <br /> (Al ~' ,25), if r~quired $___ <br /> 1:2. InvesHgation F=e (if required) $ <br /> D. Reimpcetion Fee ($'25,00) $___ <br /> <br />Receipt No. <br /> <br /> <br />