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FOR CITY VALIDATION <br />Received by:~ <br />D~te:_ <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <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 />Job Address <br /> <br />PERMITS ARE NON-TRANSFERABLE AHD EXPIRE 1F WORK IS NOT J <br />STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br />WORK 15 SUSP-I~NDED FOR 180 DAYS. <br /> <br />2A. COHTRACTOR INSTALLATION ONLY <br /> <br />2B. FOR OWNI~R INSTALLATIONS <br /> <br />Property Owner (ple~sepdnt) <br />Mailing Addreaa ] ~ne <br />City/Sm~p <br /> <br />3. PL~ RB~EW SECTION <br /> <br />~fion Co~ does not require a pl~ review. <br />We will provide pl~ review se~ice if you complete <br />S~aon 5B aM sub~t ~o (2) sets of plans ~d <br />specifications wi~ ~is application. <br /> <br /> NOV 13 1996 <br />4. FEE SCHEDULE (Complete an~t~ '~ll~l~ <br /> RESIDE~rn~a.)g~ BUILDINGcoMMERCiAL I.jINSPEC~0N <br /> USE OF STRUCT~: <br /> NEW ~ AL~ON ~ ~D~ON ~OCATION Q <br /> GAS ~ or ELEC~IO ~ <br /> H~ X Fm= S~ <br />BASE FEE $10.~ <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 <br /> 3 Ton and up <br /> <br />AIR CONDITIONER <br /> under 3 Ton <br /> 3 Tonand up <br /> <br />EvaporativeCooler <br /> <br />$ 6.50 -- <br />$11.00 -- <br /> <br />$ 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 />$7.5O <br />$ 7.50 <br />$30.00 <br /> <br />$ 7.50 -- <br />$ 7.50 -- <br />$7.50 -- <br />$ 7.50 -- <br /> <br />GAS PIPING SYSTEM <br /> 1~[ outleta (per outlet) <br /> 4 and up outlets (per ouflc0 <br /> <br />Appliance V~nts not included in <br />an appliance permit <br /> <br />OTHER (as required by B~il~g Ol~cial) <br /> <br />$ 2.00 <br />$ .50 __ <br /> <br />$ 3.00 -- <br /> <br />N/C <br /> <br />5. FI~ES Al. Enter total of fees fiom Se~. g4 <br /> A2. Add 5% surcharge (.05 x Al) <br /> <br />B. Enter 25% of line A1 for Plan Review <br />(Al + .25), if r~quired <br />C. Investigation Fee (if required) $. <br />D. Roinspecfion Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUE $ <br />Receipt No. <br /> <br /> <br />