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FOR CITY VALIDATION <br />[ Received by: <br />[ D~te: <br /> <br /> MECHANICAL PERMIT APPLICAI[I~ <br /> Plate all ~ectlons, I through <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER PERMrr NO: <br /> 285 Church St NE · Room 132 <br /> Salem, OR 97301 <br /> <br />1. LOCATION OF INSTALLATION MARION COL <br /> <br />Date: <br /> <br />24 hr, Inlpecflon Line 373-4427 <br />OIT~e: Phone 588-514'/ 8:00am - 4:30pm [~$uod by: <br /> <br /> ~ ~SIDE~ ~ COMMBRCI~ ~ <br /> U~ OF ~RU~: <br /> q~yNEW ~ AL~ON ~ ~D~ON O ~ATION ~ <br /> <br />CTiOi~s o o~ r~ECTmC <br /> <br /> BASE FEE <br /> <br /> PORCED AiR FURNACE <br /> up ~o 100.000 BTU $ 6.~ <br /> <br /> ~r ~mac~ $ 6.~ <br /> Ws~ H~[~r $ 6.~ <br /> <br />PERMFYS ARE NON-TRANSPI~RAB LIS AND EXPIRE IF WORK IS NOT <br /> STARTED wrrHhN 180 DAYS OF ISSUANC~ OR IF <br /> WORK IS SUSI~.~IDED FOR 80 DAYS. <br /> <br />2A. CONTIL~CTOR INSTALLATION ONLY <br /> <br />Mailing Addr*~ <br />Coatractor'm Licea~¢ No. <br />Contractor's Board Reg. No. lob No. <br />Comtactor's Sisnature: <br /> <br />211. FOR OWNI~ INSTALLATIONS <br /> <br />3. PLAN RBVIBW SBCTION <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 app ication. <br /> <br />REV 8/96 <br /> <br />HEAT PUMP <br /> under 3 Ton <br /> 3 Ton and up <br /> <br />AIR COHDITIOI~ R <br /> trader 3 Ton <br /> 3 Ton and up <br /> <br />EvaporaliveCooler <br /> <br /> and [h3,~ Vents <br /> <br />ADDITIONAL APPLIANCES <br /> <br /> Gas Log Lighter <br /> Gas Earbeque <br /> Other <br /> <br />$ 6.50 <br />$11.00 -- <br /> <br />$ 6.50 <br /> <br />$4.50 <br />$4.~0 <br />$4.50 <br />$4.50 <br /> <br />$ 3.00 <br />$ 3.00 <br />S7.50 <br />S 7.50 <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 />5. F~ILq <br /> A 1. Enter lotal of feea fi~nn Sec. ~4 <br /> A2. Add 5% surcharge (.05 x A I) <br /> <br />B. Enact 25% of line AI for Plan Review <br /> (Al + .25), it'required <br />C Inveadgalion Fee (ifrcquiosd) <br />D. R¢imgection Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br />Reccipl No. <br /> <br /> <br />