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FOR CITY VALIDATION <br />R~eived by: <br />, .i~to: <br /> <br />Date: 0 C T 3 ~ lq.0~ '"'~ <br /> <br />COMMUNITY DEVELOPMENT CENTER <br />285 Church St NE · Room 132 <br /> Salem, OR 97301 <br /> <br />24 Hr Insp~,t/on Line; 588-7904 <br />Off'me; 588-5147 8:00a.m.-4:30p.m. <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 />I~aipfion/I)dkecfions <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT [ <br />STARTED WITHIN lg0 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INaTALLATION ONLY <br /> <br />Property Owner (pleaseprim) <br />M~iling Addr~sa Phone <br />City/$tate/~p <br />Owner'a Signature: <br /> <br />Agent's $ign~ur~: <br /> <br />3. PLANRBVIEW 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 15-41 <br />Rev. 12/94 <br /> <br /> MARION COUNTy <br />l$$u~:{ I~ILPYlAo~ , <br /> " "v°~'ECTIOIV <br /> <br />4, FBB SCHBDULB {Caapl~l~ and enter total ~ Al bebw) <br /> ~DE~ . CO~RCI~ <br /> NEW D ~RATION ~/~D~ION~OCATION <br /> GAS ~ ~ ~EL'I'RIC <br /> N~ X P~ = Sum <br />B~ FEE <br /> <br />FORCED AIR FURNACE <br /> up to 100,000 BTU <br /> over 100,000 BTU <br /> <br />Floor Furnace <br />Suspended Heater <br />Wall Heater <br />Floor Mounted Heater <br /> <br />Hi, AT PUMp <br /> under 3 Ton <br /> $ Ton and up <br /> <br />AIR CONDIT1ONBR <br /> under 3 Ton <br /> 3 Ton and up <br /> <br />EvaporativeCooler <br /> <br />$ 6.00 <br />$ 7.00 <br /> <br />$ 6.00 <br />$ 6.0O <br />$ 6.00 -- <br /> <br />$l 1.00 <br /> <br />$ 6.50 <br />$11.00 <br /> <br />$ 4.50 <br />$ 4.50 <br />$ 4.50 . <br />$ 4.50 <br /> <br />$3.00 -- <br />$ 3.00 <br />$7.50 -- <br />$7.50 -- <br />~o.oo <br /> <br />$7.50 <br />$ 7.50 <br />$7.5O <br />$7.50 <br /> <br />GAS PIPING SYS'I~M <br /> 1-4 outlets (per outlet) <br /> 4 and up ouflete (per outlet) <br /> <br />Appliance Vents not included in <br /> · n applian¢~ permit <br /> <br />OTHER (as required by Building Ol~iaO <br /> <br />$ 2.00 <br />$ .5O <br /> <br />$ 3.00 <br /> <br />Al. Enter Iolal of fees f~om See. 1t4 <br />A2. Add 5% sm-charge (.05 x Al) <br /> $,~ <br /> <br />B. ~ter 25~ of ~ A 1 for PI~ Review <br /> (Al + ~5), if ~quk~ $.__ <br />C. ~wstiga~on Fee (if ~qui~d) $.__ <br /> <br /> TOT~ ~O~ D~ <br />R~eipt No. <br /> <br />s/7a. <br /> <br /> <br />