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FOR CITY VALIDATION <br />Received by:. <br />Date: <br /> <br />MARION COUHTY BUILDING INSPECTION ,-~ .-..~ ~, ,.~ <br /> COMMUN Y DEVELOP NT <br /> 285 Chu~h St NE · R~m 132 ' ~~ <br /> Salem, OR 97301 <br /> Dato: <br /> <br /> O~: 58~514~ 8:~ a.m. - 4:30 p.m. ]SSU~ by: <br /> F~: 58~9~ <br /> <br /> MECHANICAL PERMIT APPLICATION [ <br /> Please complete all ~ections, I through 5 <br /> <br />1. LOCATION OF n~STALLATION <br /> <br />~obAdd,'~, 945 Olney St. <br /> <br />oty Aumsville, OR aural <br />hwertyOwner Blazer Ind. m~ne 749-1900 <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF 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 />Cont~¢torSalem Heating & Sht. Mt~.Phone 581-1536 <br /> <br />MmilingAddress P.O. Box 12005, Salem, OR 97309 <br /> <br />Contractor's Board Reg. No. 1505 Job No. · <br /> <br />Contractor's Signature:(~g~ ~ <br /> <br />2B. FOR OWN~ INSTALLATIONS <br />Prol~rty Ow~r (pier,print) <br />Mailing Addre~ Phone <br />City/S-ate/Zip <br />Owner's Signature: <br />Agent'n Signnturo: <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 />4. FEE 5CHEDULB (Complete and ent~ to*al in Al below) <br /> <br /> RESIDENTIAL I~ COMMERCIAL ~ <br /> USE OF STRUCTURE: <br /> NEW ~ ALTERATION ~ ADDITION Q RELOCATION <br /> GAS C3 or ELECTRIC ~0 <br /> No. X Fee = Sum <br />BASE FEE $10.00 <br /> <br />FORCED AIR FURNACE <br />up to 100,000 BTU $ 6,00 -- <br /> over 100,000 BTU $ 7.00 -- <br /> <br />Floor Furnace $ 6.00 <br />Suspended Heater 2 $ 6.00 1-27U0 <br />Wall Heater $ 6.00 -- <br />Floor Mounted Hea~r $ 6.00 <br /> <br />HEAT PUMP <br />under 3 Ton $ 6.50 -- <br />3 Ton and up $11.00 -- <br /> <br />AIR CONDITIONER <br />under 3 Ton $ 6.50 -- <br />3 Ton nnd up $11,00 -- <br /> <br />EvaporativeCooler $ 4,50 -- <br /> <br />ADDITIONAL APPLIANCES <br />Gas Wa*ar Heater $ 7.50 <br />Gas Log Lighter $ 7.50 -- <br />Gas Barbeque $ 7.50 <br />Other $ 7.50 -- <br /> <br />GAS PIPING SYSTEM <br /> 14 outlets (per outlet) <br /> 4 and up outlets (per ouflc0 <br /> <br />Appliane~ Vents not included in <br /> · n appliance permit <br /> <br />OTHBR (ss required by Buildng O~eisO <br /> <br />DWELLING PERMIT LABEL # of Lal~la <br /> <br />$ 2.00 <br />$ 30 __ <br /> <br />$ 3.00 -- <br /> <br />N/C <br /> <br />5. FBBS <br /> Al. Enter tolal of fees from Sec. <br /> A2. Add 5% surcharge (.05 x Al) <br /> <br />~ubtntal <br /> <br />s_22-.00 <br />$ 1 .t0 <br />$__ <br /> <br />B. Enter 25% of linc Al for Plan Review <br />(Al + .25), if required $__ <br />C, Investigation F~e (ifr*quir~d) <br />D. Reinspcction Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUE $2310 <br />Ree(~pt No. <br /> <br /> <br />