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FOR CITY VALIDATION <br />Reeeivedby:, <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br />COMMUNITY DEVELOPMENT CENTER <br />285 Church St NE · Room 132 <br /> Salem, OR 97301 <br /> <br />24 Hr In~-.tion Lin~ 588-7904 <br />Office: 588-514"/ 8:00a.m.-4:30p.m. <br />FAX: $88-7948 <br /> <br />MECHANICAL PERMff APPLICATION <br />Please complete ail Sections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />Job Addl~a <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXPIRE 1F WORK IS NOT <br /> STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />FOR OWNER INSTALLATIONS <br /> <br />P~perty Owner (pl~so print) <br /> <br />Mailing Ad~s Phone <br />Ci{y/S ~te/Zip <br /> <br />Owner's Signature: <br /> <br />3, PLAN REVIEW 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 />Issued by: __~ <br /> BUILOING INSPECTION <br /> <br />4. FEE SCHEDULE (Completo and ent= totnl in A1 below) <br /> <br /> RESIDENTIAL ~ iCOMMI~tC1AL [-[ <br /> USE OF STRUCTURE: <br /> NEW r~ ALTERATION ~.ADDITION ~[REL~(~ATION Cl <br /> GAS ~ or ELECTRIC t~ ~'---~" ...... <br />~ No. X Fe~ ~ 8urn <br />BASE FEE $10.00 <br /> <br />FORCED AIR FURNACE up to lO0,000 BTU <br /> <br />FloorFumac~ $ 6.00 -- <br />Suspended Heater $ 6.O0 -- <br />Wall Heater $ 6.00 <br />FloorMoun~:dH~ater $ S.00 -- <br /> <br />HEAT pUMp <br /> uad~r 3 Ton <br /> 3Tonand up <br /> <br />AIR CONDITIONER <br /> under 3 Ton <br /> 3 Ton and up <br /> <br />$ 6.00 <br />$ 7~00 <br /> <br />$ 6.50 <br /> <br />$ 6.50 <br />$1LO0 -- <br /> <br />$4.50 -- <br />$ 4.50 <br />$ 4.50 -- <br />$ 4.50 __ <br /> <br />$ 3.0o __ <br />$ 3.00 -- <br />$ 7.50 -- <br />$7.5O __ <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 />GAS PIPING SYSTEM <br /> 14 outlets (per oullel) <br /> 4 and up outlets {per outlet) <br /> <br />Appliance Vents not included in <br />nn appllnnce permit <br /> <br />OTHER (as required by B~il~g Ol~cial) <br /> <br />DWnLLING PERMIT LABEL # of Labels <br /> <br />5. FEES <br /> A 1. Enter total of fees from Sec. ~4 <br /> A2. Add 5% aureharg~ (.05 x Al) <br /> Subtotal <br /> <br /> B. Enter 25% of line A1 for Plan Review <br /> (Al + .25), if required <br /> C. Investigation Fee (if required) <br /> D. Reimpection Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br /> Receipt No. <br /> <br />$__ <br />$__ <br /> <br /> <br />