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FOR CITY VALIDATION <br />Reoeived by:. <br /> <br />MARION COUNTY BUILDING INSPECTION <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 5885147 8:00am - 4:30pm <br />Ir.AX: 588-7948 <br /> <br />MECHANICAL PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />1. LOCATION OF I]qSTALLATION <br /> <br />PER/vffr~ ARE NON'TRANSFIa~ABL~ AND EXPIRE IF WORK iS NOT <br /> STARTED WITHIN 180 DAYS OF ISSUANCE OR <br /> WORK [8 SUSPI~'DED FOR I~0 DAYS. <br /> <br />CONTRACTOR INSTALLATION OHLY <br /> <br />Iv~iling <br />Conttuclor's Licee~e No. <br />Ceau~ctor's Board Reg. No. Job No. <br />Caouactor 'a S~namre: <br /> <br /> FOR OWHBR INSTALLATIONS <br /> <br />Owner's Signature: ~ <br />A~ent's Si~n~ce: <br /> <br />3. PLAN REVXI~W SECTION <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 1541 <br /> <br />Dine: <br />Issued by: i-' <br /> <br />4. F~E SCHIS~LILE (Complete nnd ente~ totel in A 1 below) <br /> <br /> RESIDENTIAL f-I COMMERCIAL I~ <br /> USE OF ~rkUCTURE: <br /> <br />NEW O ALTERATION <br />GAS n or ELECTRIC <br /> No. X <br />BASE FEE <br /> <br />FORCED AIR FURNACE <br />up to ]00,000 BTU I $ 6.00 <br />over 100,~00 BTU $ 7.00 -- <br /> <br />Floor Fum~c~ $ 6.00 <br />Suspended Heater $ 6.00 -- <br />WaU Heater $ 6.00 <br />Floor Mounted Healer $ 6.00 <br /> <br />HEAT PUMp <br />under 3 Ton S 6.50 <br />3 Ton and up $11.00 -- <br /> <br />AIR CONDITIONER <br />und~ 3 Ton $ 6.50 <br />3 Ton and up $11.00 <br /> <br /> and I~Te~ Vem~ $ 3.00 __ <br /> <br />14 outtea (per oufl~) o/, $ 2.00 <br /> <br />$ 3.00 <br /> <br />NIC <br /> <br />5. FEES <br />Al. Enter totalof f~ from Sec. ~t4 $ <br />A2.. Add 5% ~urcharg~ (.05 x A 1) <br /> ~b~al $,~ <br /> <br /> B. ~1~25% of~e Al f~Pl~ Review <br /> (Al * ~5), if mqu~ $.~ <br /> C. Inv~g~on ~ (if~u~) $.~ <br /> D. ~t~fl Fee (~5.~) $.~ <br /> <br /> T~ ~O~ D~ $.~ <br /> R~eipt No. <br /> <br /> <br />