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FOR CITY VALIDATION <br />Received by: <br />Date: <br /> <br />COMMUNITY DEVELOPMENT CENTER <br />285 Church St NE · Room 132 <br /> Salem, OR 97301 <br /> <br /> ~4 hr. Inspection Line 373-4427 <br />Office: Phone 588-5147 8:00am - 4:30pm <br />FAX: 588-7948 <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br /> PERMIT NO: <br /> <br /> Date: <br /> <br /> Issuod by: <br /> <br /> MECHANICAL PERMIT APPLICATION ] <br /> P/ease complete ali Sections, I through 5 <br /> <br />I. LOCATION OF INSTALLATION <br /> <br /> C r, <br /> <br />Job Description; <br /> <br />PERMIT8 ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT <br /> STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WQRK IS SUSPENDED FOR 180 DAYS, <br /> <br /> CONTRACTOR INSTALLATION ONLY <br /> I Phone <br /> <br />Contractor'sBoalxlReg. No. ll.g30~7 ^ [ ~obao. <br />C°ntra¢ I°r's Signature"C.~/.~.,~ <br /> <br />2B. FOR OWNER INSTALLATIONS <br />Property Owner (plea~e pdn0 <br />Mailing Addreas Phone <br />City/State/Zip <br />Or,net's Signature: <br />Agent's Signature: <br /> <br />3. PLANREVIBW SF:~CTION <br /> <br />4. FEE SCHEDULE (Complet~ and 0nt~r total in Al below) <br /> <br /> USE O~ STEU(TfUKE: <br /> NI~V O ALTERATION O ADDITION O RELOCATION ~ <br /> GAS O or ELECTRIC O <br /> No. X F~ = ~ <br />BASE FEE $30.00 <br /> <br />FORCED AIR FURNACE <br />up ~o 100,000 BTU $ 6.00 <br />over 100,000 BTU $ 7.00 <br /> <br />Floor Furnace $ 6.00 <br />Susp~n&d Healer $ 6.00 <br />Wall Heater $ 6.00 <br />Floor Mounted Heater $ 6.00 -- <br /> <br />HEAT PUMP <br /> under 3 Ton <br /> 3 T6n and up <br /> <br />MR CONDITIONER <br /> un~ 3 Ton <br /> 3 Ton and up <br /> <br />Evap~r~tiveCooler <br />Commercial Exhaust System <br />Commercial Hood and Exhaust <br />Domestic Range Hood <br />Domestic Exhaust Fans <br /> and Dryer V~nls <br />Flte Damper <br />Wood Stove/Fireplace <br />Furnace Ducts (Alt era~ion/Ext ~uaio n) <br />Commercial / Industrial Incinerator <br /> <br />OAS PIPING SYSTEM <br /> 1-4 outlets (per outlet) <br /> 4 and up outlets (per ou0e0 <br /> <br />Appliance Venta not included in <br />~n appliance p~rmit <br /> <br />OTHER (as required by Builc~g O~cial) <br /> <br />DWELLINO PERMIT LABEL # of Lxhcls <br /> <br />$ 6.50 <br />$11.00 <br /> <br />$ 6.50 <br />$11.00 <br /> <br />$43O <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 />$7.50 <br />$ 7.50 -- <br />$ 7.50 <br />$7,50 <br /> <br />$ 2,00 <br />$ .50 -- <br /> <br />$ 3.00 <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 15-41 <br />REV 8/96 <br /> <br />5. FEES <br />Al, Entsr total of fe~s from S~,/M $__ <br />A2. Add 5% st~¢hargo (.05 x Al) $~ <br /> <br /> B, Enter25% oflin~Al forP~ R~vJew <br /> (Al + .25), if ~qu~d $~ <br /> C. Investigation F¢~ (if ~qui~d) $~ <br /> D. R~imp~¢tion Fee ($25.~) $~ <br /> <br /> <br />