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MARION COUNTY BUILDING INSPECTION <br /> <br />FOR CITY VALIDATION <br />Received by:.~ <br />]Date: ~ <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 S: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 1]q~rALLATION <br /> <br />PERMIT NO: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />P~ A~ NON-~NS~B~ AND ~ ~ WO~ IS N~ <br /> STAR~ ~ I~ DAYS OF ISSU~ OR IF <br /> WO~ IS SUS~ FOR I ~ DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />Phone <br /> <br />MailinS Addre~a <br /> <br />~2B. FOR OWNER INSTALLATIONS <br /> <br />3. PLANRBVIBW SECTION <br /> <br />Marion County does not require a plan review. <br />We will provide plan review service if you complete <br />Seclion 5B and submit two (2) sets of plans and <br />specifications with this app ication. <br /> <br />REV 8196 <br /> <br />4. FI~I~ SCFIRDULE (Complete and enter total in A 1 b¢loW'21~ <br /> <br /> RESIDENTIAL [--I COMMERCIAL [~. <br /> USE OF STRUCTURE: · <br /> <br /> GAS CJ t~' ELEC'TRIC <br /> <br />BASE FEE No/X F~ <br />~ORC'ED ~IR PUR~ACE <br />upto 100~000 ETD $ 6.00 <br />over 100,000 BTD $ 7.0~ <br /> <br />Boor Enm~c¢ $ <br />Su~p*nd~l Heater $ 6.00 <br />Wall lt~t~r $ 6.00 <br />Floor Mounted Healer $ 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 Ton and up <br /> <br /> and Dryer Veins <br /> <br />ADDITIONAL APPLIANCES Gas Water Heater <br /> G~ Log Lighter <br /> Gu Bsd~que <br /> <br />OAS PIPINO SYSTEM <br /> 14 oudeta (per outlet) <br /> 4 and up outlet~ ([~r oull¢l) <br /> <br />Appliance Vent~ not included in <br />an appliance permit <br /> <br />OTHER (as requh~d by Building Ot~cial) <br /> <br />DWELLINO PERMIT LABEL #ofLab~la <br /> <br />5. FEES <br /> A I. Eoter total of fe~ from S~c. #4 <br /> A2. Add 5% ~urcharge (.05 x Al) <br /> Subtotal <br /> <br /> B. Enter 25% of line A I for Pla~ Review <br /> (Al + 25),if ~quit~l <br /> C. [nv~dgalion Fee (ifrequ~red) <br /> D. R~in~p¢cliOn Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br /> Receipt No. <br /> <br />$ 6.50 <br /> <br />$ 6.50 <br /> <br />$4.50 <br />$4.50 <br />S4.50 <br />$4.50 <br /> <br />S3.00 <br />$ 3.00 <br />$ 7.50 <br />$ 7.50 <br />$30.00 <br /> <br />$7..50 <br />$7.50 <br />$7.50 <br />$7.50 <br /> <br />2.00 <br /> .50 <br /> <br />$ 3.00 <br /> <br />N/C <br /> <br /> <br />