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FOR CITY VALIDATION <br />Reczived by: <br />Date: <br /> <br />MECHANICAL PERMIT APPLICATION <br />Please complete all Sections, I through $ <br /> <br />1. LOCATION OF IN~ALLATION <br /> <br />Salem, OR97301 Dato' /AH " 1111 <br /> <br /> ',,~mu~ COUN~ <br /> F~: <br /> 588-7948 <br /> BUILDING ~ .... <br /> 4. ~ ~ (C~plete ~d ~t~ ~1 ~ Al below) <br /> <br /> RESID~I~ ~ COMMERCI~ <br /> USE OF S~UCT~E: <br /> ~W ~ ~TION ~ ~D~ION~OCA~ON ~ <br /> GAS D or ELEC~IC ~ <br /> <br /> B~E FEE $10.~ <br /> <br />Gross Sir eeVDirections: ~'/~ ~"'- ~ (~t. / ¢ <br /> <br /> z~ .~-~//.>~..,~ <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT <br /> STAR'I~D wrrHIN 1~0 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />ZA. COHTRACTOR INSTALLATION ONLY <br /> <br />Mailing Addr~s ~ ~"/-/1 , _,!~,~," <br /> <br />liB, FOR OWlff~R IHSTALLATIONS <br /> <br />Propelty Owner Omlam~prYat) <br />Mailing Address Phone <br />City/State/Zip <br /> <br />Agent's Signature: <br /> <br />FORCED AIR FURNACE <br />up to 100,000 BTU $ 6.00 <br />over 100,000 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 Co~DmO~R <br /> under 3 Ton <br /> 3 Ton and up <br /> <br />EvaporativeCooler <br /> <br />Domestic Range Hood <br /> <br /> and Dryer Vents <br />Fir~ Damper~r~ /0t I r~5 C~ g, ~'~ <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 />$ 3.00 <br />$7.50 <br />$7.50 <br />$30.00 <br /> <br />$7.50 -- <br />$7.50 -- <br />$7.50 -- <br />$ 7.5O <br /> <br />GAS PIPING SYIiTEM <br /> 14 outlets (per outlet) <br /> 4 and up outlets (p~r outlet) <br /> <br />Appliance Vents not included in <br />an appliane~ permit <br /> <br />OTHER (as requited by B~ildi~ Ol~cial) <br /> <br />DWELL1HO PERMIT LA~EL # of Lal~ls <br /> <br />$ 2.00 -- <br />$ .50 -- <br /> <br />$ 3.00 -- <br /> <br />N/C <br /> <br />3. PLANR~VI]~W SBCTION <br /> <br />Marion County does not require a plan review. <br />We will pwvide 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 8~6 <br /> <br />A2. Add 5% surcharge (.05 x Al) <br /> <br />B. Enter25% of lineAl forPlanReview <br /> (Al + .25), if r~quired <br />C. Investigation Fee (if required) <br />D. R¢inspe¢tion Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br /> <br />$ ~- <br /> <br />S ~ <br />$. /gSff <br /> <br /> <br />