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FOR CITY VALIDATION <br />Received by: <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <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 588-5147 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 />Sob Address <br /> <br />PA. CONTRACTOR INSTALLATION ONLY <br /> <br />Contractor's Board Reg. No. ~ Job No. <br />Contractor's Signature: <br /> <br />2B. FOR OWNER INSTALLATIONS <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 $/96 <br /> <br />PERMIT NO: <br /> <br />Date: ___~.~. <br /> <br />Issued by: <br /> -,3 <br /> <br />4. FBB SCHEDULR (Complete and ~F.~r tomlinAl below) <br /> <br /> ~l C~MERCIAL <br /> RESIDEHTIAL <br /> USE OF STRUCTURE: <br /> NEW [3 ALTERATION [~ ADDITION <br /> GAS ~ or ELECTRIC ~1 <br /> No. X Poe = gum <br />BASE FEE $10.~0 <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 -- $ 6.00 -- <br />Wall Heater -- $ 6.00 -- <br />Floor Mounted Heater $ 6.00 -- <br /> <br />HEAT pUMp <br />under 3 Ton $ 6.50 -- <br />3 Ton and up $ l 1.00 -- <br /> <br />AIR CONDITIONER <br />under 3 Ton $ 6.50 -- <br />3 Ton and up $11.00 -- <br /> <br />EvaporativeCooler $ 4.50 -- <br />Commercial Exhaust System $ 4.50 -- <br />Commemial Hood and Exhaust $ 4.50 <br />Domestic Range Hood $ 4.50 -- <br />Domestic Exhaust Fans <br />and Dryer Vents $ 3.00 -- <br />Fire Damper $ 3.00 -- <br />Wood Stove/Fireplace $ 7.50 -- <br />Furnace Duets (Altcratiol~Ext~nsion) $ 7.50 -- <br />Commercial / IndusMal Incinerator $30.00 <br /> <br />ADDITIONAL APPLIANCES <br />Gas Water Heater ~ $ 7.50 <br />Gas Log Lighter $ 7.50 <br />Gas Barbeque $ 7.50 <br />Other $ 7.50 <br /> <br />GAS PIPING SYSTSM t~A <br />14 outlets (peroutlet) ~_~.~ $ 2.00 -- <br />4 and up outlets (p~r outlet) ' $ .50 __ <br /> <br />Appliance Vents not included in <br />an appliance permit $ 3.00 -- <br /> <br />OTHER (as required by Building Or, cia0 <br /> <br />DWELLING PERMIT LABEL # of Labels N/C <br /> <br />5. FEES <br />A 1. Enter total of fees from Sec, #4 $. <br />A2. Add 5% surcharge (.05 x Al) $ <br /> Subtotal $. <br /> <br /> B. Enter 25% of IMe A 1 for Plan Review <br /> (Al + .25), if required $_ <br /> C. Investigation Fee (if required) $_ <br /> D. Reinspeetion F,~ ($25.00) $_ <br /> <br /> TOTAL AMOUNT DUE $. <br /> Receipt No. <br /> <br /> <br />