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FOR CITY VALIDATION [ Received by: Date: MARION COUNTY BUILDING INSPECTION COMMUNITY DEVELOPMENT CENTER 285 Church St NE · Room 132 Salem, OR 97301 24 hr, Inspection Line 373-4427 Office: Phone 588-5147 8:00am - 4:30pm FAX: 588-7948 PERMIT NO: Date: Issued by: MECHANICAL PERMIT APPLICATION Please complete all ,~ections, I through 5 1. LOCATION OF INSTALLATION PER/vETS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE OR IF WORK IS SUSPENDED FOR 180 DAYS. 2A. CONTRACTOR INSTALLATION ONLY Contractor ~IV~ ~C~ I Contractor's License No. Job No. 2B. FOR OWNI~R INSTALLATIONS Pwporty Owner (p/easepri~g) Ma/ling Address Phone City/Stale/~p Owner's Signature: Agent's Signature: 3. PLANREVIRW SECTION Marion County does not require a plan review. We will provide plan review service if you complete Section 5B and submit two (2) sets of plans and specifications with this application. MC 1541 REV 8/96 4. FEE SCHEDULE (Complete and enter total in Al below) RESIDENTIAL~ COMMERCIAL USExO~ STRUCTURE."__ -- -- NEW~. ALTERATION ~ ADDITION ~1 RF-~OCATION m GAS'~ ELECTRIC~ No. X F~ = Sum or BASE FEE FORCED AIR FURNACE up to 100,000 BTU $ 6.00 -- over 100,000 BTU $ 7.00 -- Floor Furnace $ 6.00 Suspended Heater $ 6.00 Wall Healer $ 6.00 Floor Mounted Heater $ 6.~0 HEAT PUMP _~ under 3 Ton $ 6,50 3 Ton and up $11.00 AIR CONDITIONER under 3 Ton $ 5,50 -- 3 Ton and up $1L00 -- EvaporativeCooler $ 4.50 -- Commercial Exhaust System $ 4.50 -- Commercial Hood and Exhaust $ 4.50 Domestic Range Hood $ 4.50 -- Domestic Exhaust Fans and Dryer Vents $ 3.00 __ Fire Damper $ 3.00 -- Wood StovedFireplac~ $ 7.50 -- Furaace Duc~ (Alt~ation/Ex~ension) $ 7.50 -- Commercial / Industrial Incinerator $30.00 ADDITIONAL APPLIANCES Gas Water Heater $ 7.50 -- Gas Log Lighter $ 7.50 -- Gas Barbeque -- $ 7.50 -- Other $ 7.50 GAS PIPING SYSTEM , 14 outlets (peroutlet) , ~ $ 2,00 4 and up outlets (per ~udet) $ ,50 __ Appliance Vents not included in an appliance permit $ 3.00 -- OTHER (zs required by Boil&'t~ Ol~cial) DV~ELLING PERMIT LABEL # of Labels 5. Fr~s Al. Enter to,al of fees from Sec.//4 $. A2. Add 5% sur~harg~ 605 x Al) $.__ Subtotal $.__ B. Enter 25% of line Al for Plan Review (Al + .25), if required $___ C. Investigation Fee (if rcquirud) $.__ D. Reinspeetion Fee ($25.00) $ _._~__~ TOTAL AMOUNT DUE Receipt No.