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FOR CITY VALIDATIONI <br />Received by: [ <br />Date: [ <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> 285 Church St NE · Room 132 PERMIT <br /> Salem, OR 97301 <br /> <br />24 Hr Inspection Lin~: 588-7904 <br />Off'wo: 588-5147 8:00a.m.-4:30p.m. <br />FAX: 588-7948 <br /> <br />MECHANICAL PERMff APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXpIP~ IF WORK IS NOT <br /> STAR'rED WITHIN 180 DAYS OF ISSUANCE OR 1F <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />Contractor's Liceme No, <br /> <br /> voR ow R INST £ATIONS' <br /> <br />Property Owner (plesseptint) <br /> <br />Mailing Addr~s <br /> <br />City/SmtdZip <br /> <br />Owner's Signature: <br /> <br />Agent's Signature: <br /> <br />4. ~ SCH~(Compl~dem~ud~A1 below) <br /> <br /> NBW ~ AL~RATION ~ AD~~TIONO <br /> GA8 O or [~C~IC ~ <br /> No. X F~ <br />BASE FEE $10.~ <br /> <br />FORCED AIR FURNACE <br />up to 100,000 BTU $ 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 Mourned Heater $ 6.00 <br /> <br />NEAT PUMP <br />under 3 Ton ~ $ 6.50 <br />3 Ton and up $1L00 -- <br /> <br />AIR CONDITIONER <br />trader 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 ami Exhaust $ 4.50 -- <br />Domestic Rang= Hood $ 4.50 -- <br />Domestic Exhaust Fans <br />and Dryer Vents $ 3.00 -- <br />Fire Darner $ 3.00 <br />Wood Stove/Fireplace $ 7.50 . <br />Furnace Ducts (Alt~ration/Extensinn) $ 7.50 -- <br />Conunercial / Industrial Incinerator $30.00 <br /> <br />OAS PIPING SYSTEM <br /> 1-4 outlets (per outlet) <br /> 4 and up outlets (per outle0 <br /> <br />Appliance Vents not included in <br />an appliance permit <br /> <br />OTHER (as required by Buil~g Ol~ciaO <br /> <br />DWELLIiXR3 PERMIT LABEL # of Labels <br /> <br />2.00 <br /> .50 -- <br /> <br />$ 3.00 <br /> <br /> 3. PLAN RBVIEW 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 1.5-41 <br />R~v. 12/94 <br /> <br />FEES <br />A 1. Enter total of fees flora Sec. {~4 <br />A2. Add 5% surcharge (.05 x Al) <br /> Subtotal <br /> <br />B. Enter25% of lineAl for Plan Review <br /> (Al + .25), if required <br />C. Investigation Fee (if required) <br />D. Reimpeetion Fe~ ($25,00) <br /> <br /> TOTAL AMOUNT DUE <br />Receipt No. <br /> <br /> <br />