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FOR'CITY VALIDATION [ <br />Received by:. <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER P~:FIMIT NO: <br /> 285 Church St NE · Room 132 <br /> Salem, OR 97301 <br /> <br /> 24 hr. Inspection Line 373-4427 <br />Office: Phone $88-5147 8:00am - 4:30pm <br />FAX: 588-7948 <br /> <br /> MECHANICAL PERMIT APPLICATION <br /> Please complete all Sections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />Cr~a Street/Directions: <br /> <br />IPERIVffrs ARE NON-'HLacNSFERAB LE AND EXPIRE IF WORK IS NOT <br /> STARTED WITHIH 1~0 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br /> 2A. COHTRACTOR INSTALLATION ONLY <br /> <br /> 2B. FOR OWNER INSTALLATIONS <br /> <br />Ovn~r's Signature: <br /> <br />A~nt'm Signature: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />4. FEE ~CHEDULE (Complete and ent~ tolei in Al b~low) <br /> <br /> RF~IDENTIAL O COMMERCIAL I-Il <br /> USE OF STRUCTURE: <br /> NEW D ALTERATION Q ADDITION <br /> GAS ~ or ELECTRIC <br /> No. X Fee = Sum <br />BASE FEE $1o.00 <br /> <br />FORCED AiR FURNACE <br />up to 100,000 BTU $ 6.00 <br />ov=r 100.000 BTU $ 7.00 <br /> <br />Floor Furnace $ 6.00 <br />Suspended Healer $ 6.00 <br />Wall Heater $ 6.00 <br />Fleer Mouutud Heater $ 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 Tonand up $11.00 <br /> <br />EvaperativeCeoler $ 4.50 -- <br />Conunercial Exhaust Syslem $ 4.50 -- <br />Commercial Hood and Exhaust $ 4.50 -- <br />Domestic Range Hood $ 4.50 -- <br />Domestic Exhaust Fans <br />and Dryer Vents $ 3.00 -- <br />Fit~ Damper $ 3.00 -- <br />Wood Stove/FLmplac~ $ 7.50 -- <br />Furnace Ducts (Alteration/Ext~msion) $ 7.50 -- <br />Commercial / Industrial Incinerator $30.00 <br /> <br />ADDmONAL APPLIANCES <br />Ga~ Water Heater $ 7.50 -- <br />Gas log Lighter $ 7.50 -- <br />Gas Barbeque $ 7,50 -- <br />Oth*r $ 7.50 -- <br /> <br />GAS PIPING 8YSI'EM <br /> 14 outlets (per outlet) <br /> 4 and up outlets (per outlet} <br /> <br />Appliance Veut~ net included in <br />an appliance permit <br /> <br />OTHER (as tvquired by Buil~ng O~ciM) <br /> <br />D~gELLING PERMIT LABEL # of Labels <br /> <br />$ 2.00 i <br />$ .5O __ <br /> <br />$ 3.00 -- <br /> <br />N/C <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 />MC 1541 <br />REV 8/96 <br /> <br />5. FEES <br /> A 1. Enter total of fe~ f~om S~, #4 <br /> A2. Add 5% surcharg~ (.05 x Al) <br /> <br /> B. Enter 25% of linc A 1 for Plan Review <br /> (A 1 + .25), if requked <br /> C. Investigation Fee (if requirud) <br /> D. R¢inspeetion Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUI~ <br /> Receipt No. <br /> <br /> <br />