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4 <br /> <br />FOR CITY VALIDATION <br />Reoeivzd by: <br />Dato: <br /> <br />COMMUNITY DEVELOPMENT CENTER --. <br />285 Church St NE · Room 132 PERMIT ~: <br />Salem, OR 97301 <br /> <br /> 24 hr, Inspection Line 373-4427 <br />Office: Phone 588-5147 8:00am - 4:30pm <br />FAX: 588-7948 <br /> <br />Da~o: <br /> <br />Issued by: <br /> <br /> MECHANICAL PERMIT APPLICATION <br /> Please complete all Sections, I through 5 <br /> <br />1. LOCATION O]f INSTALLATION <br /> <br />WO~ IS SUS~ FOR 1~ DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />Conlractor I Phone <br />Mailing Address <br /> <br />Comractor's License No. <br />Contractor's Board R~g. No. I lob No. <br /> <br />26. ]flOR OWNER INSTALLATIONS <br /> <br />Owner's Signal: ~/~ ~ ~' <br /> <br />4. ]f]~E SCHBDUL]~ (Complete and enter tolnl in A 1 below) <br /> <br /> RESIDENTIAL [~ COMMERCIAL [~ <br /> USE OF STRUCTURE: <br /> NEW Q ALTERATION Q ADDITION Cl RELOCATION Cl <br /> GAS r~ or ELECTRIC C3 <br /> No, X Fe~ = Sum <br />BASE FEE $10.00 <br /> <br />FORCED AIR FURNACE <br />up~o 100.000BTU $ 6,00 -- <br />over 100,000 BTU $ 7.00 <br /> <br />HoorFumace $ 6.00 -- <br />Suspended Heater $ 6.00 -- <br />Wall Heater $ 6.00 -- <br />Floor Mounted Heater $ 6.00 -- <br /> <br /> ~nder 3 Ton $ 6.50 -- <br /> 3 Ton and up $11.00 -- <br /> <br />AIR CONDITIONER <br />under 3 Ton $ 6.50 <br />3 Ton and up $11.00 -- <br /> <br />EvaporativeCooler $ 4.50 -- <br />Commercial Exhausl Syslem $ 4.50 -- <br />Commercial Hood and Exhaust $ 4.50 <br />Domesfc Range Hood $ 4.50 -- <br /> <br /> and Drye~ Vents $ 3.00 -- <br /> <br />ADDITIONAL APPLIANCES <br />Gas Water Heater $ 7,50 -- <br />Gas Log Lighter $ 7,50 -- <br />Gas Bat°oequ~ $ 7.50 -- <br />Other $ 7.50 -- <br /> <br /> GAS PIPING SYSTEM 1~{ outlets (per outlet) <br /> 4 and up outlets (per oufle0 <br /> <br /> Appliance Venls not included in <br /> an appliance permit <br /> <br />.. OTHER (as required by Baildiqg O~cial) <br /> DWELLING PERMIT LABEL ff of Labels <br /> <br />$ 2.00 -- <br />$ .50 -- <br /> <br />$ 3.00 -- <br /> <br />N/C <br /> <br />3. PLAN RBVIBW 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 1541 <br />REV 8/96 <br /> <br />5. FEES <br /> Al. Emcr total of fees from Sec. fi4 <br /> A2. Add 5% am~harge (.05 x Al) <br /> Subtotal <br /> <br /> B. Enter 25% of line Al for Plan Review <br /> (A 1 + .25), if required <br /> C. Investigation Fee (if requi~d) <br /> D. Reinspeetion Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br /> Receipt No. <br /> <br />$ <br /> <br />$.__ <br /> <br /> <br />