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03/08/96 11:31 <br /> <br />NOR CITY VALIDATION <br />Reaeiv~l by: , <br />Dato: <br /> <br />588 7948 <br /> <br />BLDG INSPECTION ~001 <br /> <br />COMMUNITY DEVELOPMENT CENTER PERMrrNO: qq' <br /> <br />285 Church St NE · Room 132 <br />Salem, OR 97301 <br /> <br />24 Hr laep~tinn Line: 588-"/904 <br />Office: 588-5147 $:00a.m.-4:3Op.m. <br />FAX: 588-?948 <br /> <br />Date: <br /> <br />Issued by: <br /> <br /> MECHANICAL PERMIT APPLICATION I <br /> Please complete all Sections, I through $ <br /> <br />1. LOCATION OF INSTALLATION <br /> <br /> ,ss <br /> <br />PERMITS ARE NON-TRAN SPF.,RAB LE AND EXPIRB IF WORK IS NOT <br /> STARTED WITHIN 1~0 DAYS OF ISSUANCE ORIF <br /> WORK IS SUSPENDED FOR l~0 DAYS. <br /> <br />liB. FOR OWNER INSTALLATIONS <br />Property Ow~r (p/e~pri~) <br /> <br />M~tlin8 Adg~as [ Fnoa~ <br /> <br />Citylatate/Z~p <br /> <br />Owner's SiSnntu.'~: <br /> <br />A~nt's $1~matum: <br /> <br />4. FEE 5~HEDULB (Complete and ent~' t,~ml in Al t~low) <br /> <br /> USE OF ~UCT~: <br /> NEW G AL~A~ON ~ ~D~ON ~ ~ATION ~ <br /> GAS ~ ~IC ~ <br /> <br />~ FEE $10,~ <br /> <br />FORCED AIR FURNACE <br /> up to 100,0On BTU <br /> over 100D00 BTU <br /> <br />Floor Fumac~ <br />Suspead~ Heat~ <br />Wall Healox <br /> <br />HBAT PUMP <br /> un~r 3 Tou <br /> S To, and ~ <br /> <br />AIR COND1TIOI~;R <br /> uaa~r 3 Ton <br /> 3 T~ and up <br /> <br />EvaporativeCool~r <br />C. omme~ial Exhaust System <br />Commemial Hcod and lLxhawt <br />Domestic Range H[~[ <br />Dom~i~ E~heuat F~ <br /> and DOy~ V~ <br /> <br />Wood Stove4Pkeple~ {~O-~ <br /> <br />Commemial ! I~dmlrlel ln~iaarator <br /> <br />ADDITIONAL APPLIANCE8 Oge Water Heater <br /> Oas Log Lishte~ <br /> O~ Barbequ~ <br /> <br />OAS PIPING 8YSFNM <br /> 1-4 o~t~s (i~r outle0 <br /> 4 and up oudet~ (per omit) <br /> <br />A~a v~ ~ ~ ~ <br /> ~ a~i~ p~it <br /> <br />6.O0 <br />7,00 <br /> <br />$ 6.00 <br />S 6.00 ...... <br />$ 6OO <br />$ 6.OO <br /> <br />$ 6.5O <br /> <br />$ 6.50 <br />$IL00 <br /> <br />$4,50 <br />$4,50 <br />$430 <br /> <br />$3.O0 <br /> <br />$?.$o <br />$ 7.50 <br />$30,00 <br /> <br />$7.50 <br />$ 7,5O <br />$7,50 <br />$ 7,50 , <br /> <br />$ 3.00 __ <br /> <br />DWELLING PERMIT LABEL # of Labels NIC <br /> <br />3. PLANREVIBW SECTION <br /> <br />Marion County do~ 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 />15.41 <br />12./94 <br /> <br /> <br />