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FOR CITY VALIDATIO~ <br />[ Received by: <br /> Date: <br /> <br />~~~UILDING INSPECTION <br /> CO~N_ITY~VELOPMENT CENTER oc~nff NC~ <br /> ~ur~St NE. Room 132 ....... : <br /> Salem, OR 97301 <br /> Dato: <br /> ~0~wection Line 373~427 ~ <br /> I~1~8a'5147 8:00am - 4:30pm Issu~ by: <br /> F~: 588-7948 <br /> <br /> MECHANICAL PERMIT APPLICATION <br /> Please complete all Sections, I through 5 <br /> <br />1. LOCATION OF 1318TALLATION <br /> <br />I PERMITS ARE NON-TRANSFERABLE AHD EXPIRE IF WORK iS NOT <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />Contra¢l~r's Licena~ No. <br /> <br />2B. FOR OWH~R INSTALLATIONS <br /> <br />P~perty Owner (plesso print) <br /> <br />Mailing Addlx~S Phone <br /> <br />Ci~/stata/zip <br /> <br />Agent's Signature: <br /> <br /> PLAN RBVIRW 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 application. <br /> <br />4. FEE 5CHBDULB (Completa and enter total in Al below) <br /> <br /> use oF s'rRocTtm~.: I,~Y~[~. U~ V~ <br /> NEW [3 ALTERATION CI ADDFrlO~RELO'~eATION ~ <br /> GAS g or ELECTRICS> <br /> No. X Fee = Sum <br />BASE FEE $10.00 <br /> <br />FORCED AIR FURNACE <br />up to 100,000 BTH $ 6.00 __ <br />over 100,000_B~U $ 7.00 <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 Ton and up <br /> <br />EvaporativeCooler <br />Commercial Exha~t System <br />Commercial Hood and Exhaust <br />Domestic Range Hood <br /> <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.oo__ <br />$ 3.00 <br />$7.50 __ <br />$ 7,50 -- <br />$30.00 -- <br /> <br />ADDITIONAL APPLIANCES <br /> Gas Water Heater <br /> Gas Log Lighter <br /> Gas Barbeque <br /> Other <br /> <br />$ 7.50 -- <br />$ 7.50 -- <br />$ 7.50 <br />$ 7.50 <br /> <br />OAS PIPING SYSTEM <br /> 14 outlets (per outlet) <br /> 4 and up outlets (per outer) <br /> <br />Appliance Vents not included in <br />an appliance permit <br /> <br />OTHER (ss required by Buil~g O~cial) <br /> <br />DWELLIHO PERMIT LABBL # of Lxh~ls <br /> <br />$ 2.00 -- <br />$ 30 __ <br /> <br />$ 3.00 -- <br /> <br />N/C <br /> <br />5. FBBS <br /> A i. Enter total of fee~ from Sec. #4 <br /> A2. Add 5% sumha~ge (.05 x Al) <br /> <br />B. Enter 25% of line A 1 for Plan Review <br /> (Al + .25), if required <br />C. Investigation Fee (if require, d) <br />D. Reinspection Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUE <br />Receipt No. <br /> <br />$ 17,' <br /> <br /> <br />