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FOR CITY VALIDATION <br />Received by: <br />Date: <br /> <br />MARION COUNTY BUILDING RqSPECTION <br />COMMUNITY DEVELOPMENT CENTER <br />285 Church St NE · Room 132 <br /> Salem, OR 97301 <br /> <br /> 24 hr. Inspection Line 373-4427 <br />Office: Phone 588-$147 8:00am - 4:30pm <br />FAX: 588-7948 <br /> <br />Date: <br /> <br />Issued by: <br /> <br /> MECHANICAL PERMIT APPLICATION <br /> Please complete all Sections, I through 5 <br /> <br />I. LOCATION OF INSTALLATION <br /> <br />PERIvliTS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT <br /> STARTED WITHIN I~0 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPEI~DED FOR 1~0 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br /> % <br />l~iling Addr~ <br /> <br />Con~rnclor's Board Reg, No. ] Job No. <br />Comrnc~or's Sisnature: <br /> <br />2~. FOR OWHtiR INSTALLATIONS <br /> <br />~ent's <br /> <br />4. F]~B SCHEDULB (Complete and enter total h~ A1 below) <br /> <br /> RESIDENTIAL [~ COMMERCIAL I~ <br /> USE OF STRUCTURE: <br /> NEW 12 ALTERATION 12 ADDITION 12 RELOCATION <br /> GAS O or ELECTRIC g] <br /> No. X Fe~ = Sum <br />BASE FEE $10.00 <br /> <br />FORCED AIR FURNACE <br />up to 100,000 BTU $ 6.00 -- <br />over IOO,000 BTU $ 7.00 <br /> <br />FloorFumace $ 6.00 -- <br />Suspended Heater $ 6.00 -- <br />Wall Heater $ 6.00 -- <br />Floor Mounted Heater $ 6.00 -- <br /> <br />HEAT pUMP <br /> under 3 Ton <br /> 3 Ton and up <br /> <br />AIR CONDITIONER <br /> under 3 Ton <br /> 3 Ton and up <br /> <br />EvaporativeCooler <br /> <br />$ 6.50 -- <br />$11.00 -- <br /> <br />$ 6.50 -- <br />$11.OO -- <br /> <br />$4.50 <br />$ 4.50 <br />$ 4.50 <br />$ 4.50 <br /> <br />$ 3.OO __ <br />$7.50 __ <br />$7.50 -- <br />$30.00 -- <br /> <br />ADDITIONAL APPLIANCES Gas Water Heater <br /> Gas Log Lighter <br /> <br /> Other <br /> <br />$7.50 -- <br />$7.5O __ <br />$7.50 __ <br />$7.50 -- <br /> <br />GAS PIPING SYSTEM <br /> 14 outlets (per outlet) <br /> 4 and up outlets (per outieO <br /> <br />Appliance Vents not included in <br />an appliance permit <br /> <br />OTHBR (as required by Building Ol~cial) <br /> <br />DWELLING PERMIT LABEL # of Labela <br /> <br />$ 2.00 -- <br />$ .50 <br /> <br />$ 3.OO -- <br /> <br /> 3. PLAN RBVIBW SBCTION <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 phns and <br />specifications with this application. <br /> <br />MC 1541 <br />REV 8/96 <br /> <br />5. FEES <br />Al. Enter total of fees from S~c. fi4 $. <br />A2. Add 5% surcharge (.05 x Al) $____ <br /> Subtotal $. <br /> <br /> B. Enter 25% of line Al for Plan Review <br /> (Al + .25), if required $ <br /> C. Investigation Fee (if required) $ <br /> D. Reinspcction Fee ($25.00) $ <br /> <br /> TOTAL AMOUHT DUE $ <br /> Receipt No. <br /> <br /> <br />