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IFOR CITY VALIDATION <br /> Received by.' <br /> Date: <br /> <br /> Salem, OR 7301 12 1996 <br /> Date; <br />24 Hr Inspection Lin~ 58~ <br />O~ 5~-514T 8:~ a.m. - 4:30 p.m. I~u~o~LDING <br />F~: 58~9~ <br /> <br /> MECHANICAL PERMIT APPLICATION <br /> Please complote all Sections, 1 through 5 <br /> <br />L LOCATION OF [NSTALLATI. QN <br /> <br />: I pl~aMrr$ ARElqON-TRANSFEIIABLEAND EXPIREIF WORK 1S NOT <br />%[ STARTED WlTHI~ 180 DAYS OF ISSUANCE OR IF <br />1"'i>'' , WORK IS SUSPENDED FOR, 80 DAYS. <br /> <br /> 2A. ~ ONLY <br /> <br />4. FI~]~ $CIt~DUL~ (Complete and enter total in A1 below) <br /> <br /> R~IDE~ COMMERCI~ ~ <br /> USE OF STRU~: <br /> NEW ~ ~ON ~D~ION ~ATION~ <br /> OAS <br /> ELE~I~ N~ X P~ - <br />BASE F~E $1~ffi <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 /> u~der 3 Ton <br /> 3 Tonand up <br /> <br />· ~g co~mot~R <br /> under 3 Ton <br /> 3 Ton and up <br /> <br />$ 6.$0 <br />$11.00 <br /> <br />$ 6.50 <br />$11.00 <br /> <br />$4.~0 <br />$4,~0 <br />$4.50 <br />$4.50 <br /> <br />$ 3.00 <br />$ 3.00 <br />$7.5O <br />$ 7.50 <br /> <br />2B. FOR OWtCER INSTALLATION8 <br />Pro~ Ov~er (plea~ pdn0 <br /> <br />Mailing Addeeas [ <br /> <br />City/State/Zip <br /> <br />Owner'n Signntu~e: <br /> <br />Agent's Signature: <br /> <br />GAS PIPINO SY~FEM <br /> 14 outlets (per outle0 <br /> 4 and up outlets (per oufle0 <br /> <br />Appliance Ven~ not ~cl~ M <br /> <br />~HER (~s ~ui~d by B~I~ O~eiaO <br /> <br />DWE~ING PE~ff L~L ~ of ~ <br /> <br />$ 7.50 <br />$ 7,50 <br />$ <br />$7.50 <br /> <br />$ 2.00 <br />$ .50 <br /> <br />$3.00 <br /> <br />N/C <br /> <br />3. PLANREVIEW SI~CTION <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 />R~v. 12/94 <br /> <br />Al. Enter total of fees flora S~- ~4 <br />AZ Add5% surcharge (.05 X Al) <br /> <br />B. Entar 25% of lineal for Plan Review <br /> (Al + .25), if required <br />C. Investigation Fe, (if required) <br />D. Rein~pection Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br />R~cipt No. <br /> <br /> <br />