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FOR CITY VALIDATION <br />Received by: <br />Dato: <br /> <br /> 96--11-18 <br /> 0 <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DE'VELOI:'MENT CEN'I~R <br /> 285 Church St NE · Room 132 PERMIT NO: <br /> Salem, OR 97301 <br /> Date: <br /> <br /> 24 hr. Inspection Line 3?3-4427 <br />Office: Phone 588-5147 8:00am - 4:30pm <br />FAX: 588-7948 <br /> <br />Issued by: <br /> <br />MECHANICAL PERMIT APPLICATION <br />Please complete all Sections, I through $ <br /> <br />· 1. LOCATION OF INSTALLATION <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />Contraotor'$ License No. <br /> <br />Conlractor'a Board Reg. No. <br /> <br />lC)CIO <br /> <br />Job No. <br /> <br />2,B. FOR O~ INSTALLATIONS <br />Prope~y Owner 0~/e~s~print) <br /> <br />Mailing Address Phone <br /> <br />City/State/Zip <br /> <br />Owner's Signature: <br /> <br />Agent's Sigaature: <br /> <br />3, PLAN RtiVIBW SECTION <br /> <br />Marion County does Eot 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 />4. FBE SCHEDULE (Complete ~nd enter tolal i~ A 1 below) <br /> <br /> RESIDENTIAL ]~ COMMERCIAL <br /> USE OF STRUCTURE: <br /> NEW[~ ALTERATION ~- ADDITION I~ RELOCATION n <br /> GAS ~,. or ELECTRIC ~ <br /> No. X Fe~ =, Sum <br />BASE FEE $10~00 <br /> <br />FORCED AIR FURNACE <br />up to 100,000 BTU [ $ 6,00 <br />over 100,000 BTU $ 7.00 <br /> <br />Floor Fumac= $ 6.00 <br />Suspended Heater $ <br />Wall Heater $ 6.00 <br />FloorMoun~ed Heater $ 6.00 -- <br /> <br />HEAT PUMP <br />under 3 Ton $ 6.50 -- <br />3 Ton and up $11.00 -- <br /> <br />AIR CONDITIONER <br />under 3 Ton $ 6.50 <br />3 Ton and up $11.00 -- <br /> <br />EvapomtiveCooler $ 4.50 <br />Commercial Exha~at System $ 4.50 -- <br />Co,inner,iai Hood m~d Exhaust $ 4.50 __ <br />Domestic Range Hood $ 4.50 -- <br />Domestic Exhaust Fans <br />mad Dr/er Vents $ 3,00 -- <br />Fi~e Damper $ 3.00 -- <br />Wood Stove/Fi~place $ 7.50 -- <br />Furnace Duct~ (Alteration/Extension) $ 7.50 -- <br />Commercial ! Iadustrial Incinerator $30.00 -- <br /> <br />,5O <br /> <br />$ 3,00 -- <br /> <br />N/C <br /> <br />5. F~BS <br /> Al. Enter to~aloffees fiom Sec. g4 <br /> A2. Add 5% surcharg~ (.05 x Al) <br /> ~ubtotal <br /> <br /> B. Enter 25% of lineAl for Plan Review <br /> (Al + .25), if required <br /> C. Investigalion Fee (if required) <br /> D. Reimpeetion Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br /> Receipt No. <br /> <br /> <br />