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FOR CITY VALIDATION Received by: Date: COMMUNITY DEVELOPMENT CENTER 285 Church St NE · Room 132 S~em, OR 97301 D~o: ~ Hr ln~tion L~e: 58~7~ O~: 5~S147 8:~a.m.-4:30p~. Issu~ I MECHANICAL PERMIT APPLICATION I I Please complete all Sections, I through 5 1. LOCATION OF INSTALLATION PERMITS 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 INS'FALLATION ONLY 2B. FOR OWNER INSTALLATIONS Pml~ny Owno~ (ple~sepruiO Mailing Address Phone City/Stata/Zip 3. PLANRI~VIEW SECTION Marion County does not require a plan review. We will provide plan review service if you complete I Section 5B and submit two (2) sets of plans and specifications with this application. MC 15-41 4. FEE SCHRDULE (Complete sad enter total in A1 below) RESIDENTIAL ~COMMERCL~L USE OF STRUCTURE: NEW ~1 ALTERATION ~ADDITION 121 RELOCATION 121 GAS~ or ELECTRIC [3 No. X Fee BASE FEE PORCED AIR FURHACE up to 100,000 BTO ~ $6,00 over 100,000 BTU $ 7.00 Floor Furnace $ 6.00 Suspended Heater $ 6.00 Wall Heater $ 6.00 Floor Mounted Heater $ 6.00 $ 6.50 -- $11.00 __ $ 6.50 -- $11.00 __ HEAT pUMp under 3 Ton 3 Ton and up AIR COi~)lTIOl~gR under 3 Ton 3 Ton and up EvaporativeCooler $ 4,50 -- Commercial Exhaust System $ 4.50 -- Commercial Hood and Exhaust -- $ 4,50 -- Dom~slic Raage Hood $ 4,50 -- Domestic Exhaust Fans and Dryer Vents $ 3.00 -- Fire Damper $ 3.00 -- Wood Stove/Fireplsce $ 7.50 -- Furnace Ducts (AReratiouiExtenaion) $ 7,50 -- Commercial / Indusa'ial Indn~ator $30.00 -- ADDITIONAL APPLIANCES Gea Water Heater $ 7,50 -- Ga~ Log Lighter $ 7.50 -- Gas Baroque $ 7.50 -- Other $ 7.50 -- GAS PIPING SYSTEM l-4outlets(peroutlet) ~ $ 2,00 .~. ~ 4 and up outlets (per outlet) $ ,50 -- Appliance Vents not included in an appliance permit $ 3.00 -- OTHER (as requited by Building Official) DWELLINO PERMIT LABEL # of Labels 5. FEES A 1. Enter total of fees front Sec. ~4 $ _~_/_~ A2. Add 5% nur~harge (.05 x Al) Subtotal ~ I ~-~. B. Enter 25% of lineAl for Plan Review (Al + .25), if mquil~d $__ C, Investigation Fcc (if rgquiregl) $.~ D. Reinspection Fee ($25.00) $__ TOTAL AMOUIqT DUE $. ! ~'' q0 Receipt No.