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FOR CITY VALIDATION <br />Received by:. <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER ........ <br /> 285; Church St NE * Room laz ' <br /> Salem, OR 97301 <br /> Date: <br /> <br /> 2~ Hr Inspection Line: 588-7904 <br /> Off'w.o: 588-5147 8:00a.m.-4:30p.m. Issued by: <br /> FAX: 588-'/948 <br /> <br /> MECHANICAL PERMIT APPLICATION <br /> Please complete all ~ections, 1 through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT <br /> STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />Contractor's License No, [ <br />Con~raetor's Board Reg. No. Job No. <br /> <br />2B. FOR OWHER INSTALLATIONS <br />Pmpeity Owner (pleasepdra) <br />Mailing Address Phone <br />City/StatedZip <br />Owner's Signature: <br />Agent's Signature: <br /> <br />3. PLAN REVIEW 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 />MC 15~I1 <br /> <br />4. FEE SCHI/DULE (Complete and entex total in A1 below) <br /> <br /> RESIDENTIAL ]~ COMMERCIAL I~l <br /> USE OF STRUCTURE: <br /> NEW El ALTERATION }l~ ADDITION ~ RELOCATION <br /> GAS ~ or ELECTRIC <br /> Ho. X Foo = Sum <br />BASE FEE $10.00 <br /> <br />FORCED AIR FURNACE <br />up to 100,000 BTU $ 6.00 __ <br />over 100,000 BTU $ 7.00 <br /> <br />FloorFumaee $ 6.00 -- <br />Suspended Heater $ 6.00 <br />Wall Heater $ 6,00 <br />FloorMountad Heater $ 6.00 -- <br /> <br />HEAT PUMP <br /> under 3 Ton <br /> 3 Ton and up <br /> <br />AIR CONDITIONER <br /> trader 3 Ton <br /> 3 Ton and up <br /> <br />EvaporativeCooler <br />Commercial Exhaust System <br />Commercial Hood and Exhaust <br />Domestic Range Hood <br />Domestic Exhaust Fans <br /> <br />$ 6.50 <br />$11.00 <br /> <br />$ 6.50 <br />$1L00 -- <br /> <br />$ 4,50 -- <br />$ 4.50 -- <br />$ 4.50 <br />$ 4.50 <br /> <br />$3.00 __ <br />$ 3.00 -- <br />$7.50 -- <br />$7.50 -- <br />$30.00 -- <br /> <br />ADDITIONAL APPLIANCES <br /> Gas Water Heater <br /> Gas Log Lighter <br /> Gas Barbeque <br /> Other <br /> <br />$ 7.50 -- <br />$ 7.50 -- <br />$ 7.50 -- <br />$ 7.50 -- <br /> <br />OAS PIPING SYSTEM <br /> 1-4 outlets (per outlet) <br /> 4 and up outlets (per outlet) <br /> <br />Appliance Vents not included in <br />an appliance permit <br /> <br />OTHER (as required by Buildggg O~cial) <br /> <br />DWELLING PERMIT LABEL # of Lal~la <br /> <br />$ 2.00 -- <br />$ ,50 -- <br /> <br />$ 3.00 <br /> <br />NIC <br /> <br />5. FEES <br /> A 1. Enter total of fees from Sec. i/4 <br /> A2. Add 5% surcharg~ (,05 x Al) <br /> Subtotal <br /> <br /> B. Enter25% of lineAl for Plan Raviaw <br /> (A 1 + .25), if required $ <br /> C. Investigation Fee (if required) $___ <br /> D. Rein~pection Fee ($25.00) $.__ <br /> <br /> TOTAL AIVIOUNT DUE <br /> Receipt No. <br /> <br /> <br />