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I <br />FOR CITY VALIDATION ] <br />Received by:. <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br />COMMUNITY D ~V[~LOPMYaNT ~R <br /> <br />MECHANICAL PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />Cross Street/Directions: Aumsville ~wav <br /> <br /> NOT <br /> <br />WORK IS SUSPI~IqDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br />Co.~actor Salem Htg. a Sht. Mtl.1 Vho.e 581-1536 <br /> <br />MailingAddr~s P.O. Box 12005 Salem OR 97309 <br /> <br />Contractor's License No. <br /> F <br />Contractor's Board Reg. No. 1505 [ Job No. <br /> <br /> 2B. FOR OWNER II~ISTALLATION$ <br /> <br /> Property Owner ~l~ p~) <br /> ~il~g Add~s I ~ne <br /> City/S~p <br /> <br /> ~r's Si~at~: <br /> <br /> 3. PL~HW S~TION <br />[Madon Co~ does not ~quire a plan review. <br /> We will provide pl~ review se~ice if you complete <br /> S~fion 5B ~d submit mo (2) se~ of pla~ ~d <br /> specifications wi~ ~is applicaOon. <br /> <br /> MC 1541 <br /> <br />FAX: 588-7948 <br /> COUNT~ <br /> ! ~ ~J~]~ ~¥I E DULE (Comp let ~ and enter total in Al below) <br /> <br /> RESIDENTIAL [~ COMMERCIAL I~ <br /> USE OF STRUCTURE: <br /> NEW ~ ALTERATION I~ ADDITION UI RELOCATION <br /> GAS I~ or ELECTRIC I~l <br /> No. X P~e = Enm <br /> BASE FEE $10.00 <br /> <br />FORCED AIR FURNACE <br />up to 100,000 BTU $ 6.00 __ <br />ov~r 100,000 BTU $ 7.00 <br /> <br />Floor Fumace $ 6.00 <br />Suspended Heater ~ $ 6.00 ~Q0 <br />Wall Heater $ 6.00 <br /> <br /> and Dl3,er Vents $ 3.00 -- <br /> 14 outlets (per outlet) .--2-- $ 2.00 -~L~O <br /> <br />Appliance VenU~ not included in <br />an appliance permit $ 3.00 -- <br /> <br />OTHER (ss tvquitvd by Buil~qg OfficiM) <br /> <br />DWELLING PERMIT LABEL # of L~ls ~ <br /> <br />5. FEES <br /> A 1. Enter total of fees from See, g4 <br /> A2. Add 5% surcharge (.05 x Al) <br /> Subtotal <br /> <br /> B. Enter 25% of line A1 for Phm Review <br /> (Al + .25), if required <br /> C. Investigation Fee (if required) <br /> D. Reinspeetinn Feg ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br /> Receipt No, -- <br /> <br />s. 27.30 <br /> <br /> <br />