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FOR CITY VALIDATION <br />Received By: <br /> <br />Date: <br /> <br /> MARION COUNTY <br />BUILDING INSPECTION DIVISION <br /> 3150 Lancaster Dr. NE - Suite C <br /> Salem, Oregon 97305-1398 <br /> <br /> 24 HR Inspection Line 373-4427 <br />Office: phone 588-5147 8:00am - 4:30pm <br />FAX 588-7948 <br /> <br />PERMIT NO: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />MECHANICAL PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br /> ,OB D, S 107.-2.1 LEULi mg-t0 ED SE <br /> <br /> CROSS S~/ <br /> <br /> PROJECT DESCRIPTION ~) ~e.~... <br /> <br /> PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT I <br /> STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> I <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />:gA. CONTRACTOR INSTALLATION ONLY <br /> <br />2B. FOR OWNER INSTALLATIONS <br /> <br /> Property Owner (please prinO <br /> <br /> Mai[ing Address <br /> <br /> City, State, Zip <br /> <br /> Owner's Signature <br /> <br /> Agent's Signature <br /> <br />3. PLAN REVIEW 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 />4. FEE SCHEDULE (Complete and enter total in Al below) <br />RESIDENTIAL ~ COMMERCIAL ~ USE:. <br />NEW [] ALTERATION [] ADDITION {~ RELOCATION [] REPLACE [] <br /> GAS I~ ELECTRIC [] <br />BASE FEE ASSESSED ON ALL APPLICATIONS $10.00 <br /> <br />FURNACE OTY <br />FORCED AIR UP TO 100,000 BTU x $6.00 <br />FORCED ddR OVER 100,00O BTU x $7.00 = $ __ <br /> <br />FLOOR FURNACE x $6.00 = $ .- <br /> <br />DUCTS (ALTERATION/EXTENSION) __ x $7.50 = $ __ <br /> <br />~qAS FURNACE {up to 100,000 BTU) x $6.00 = $ __ <br />GAS FURNACE (over 100,000 BTU) x $7.00 = $ <br />GAS ~REPLACFdlNSERT x $7.50 = $ __ <br />GAS WATER HEATER x $7.50 = $ __ <br />GAS LOG LIGHTER x $7.50 = $ <br />GAS BARBEQUE x $7.50 = $ __ <br /> <br /> GAS PIPING <br /> Each outlet up m 4 outlets x $2.00 = $ __ <br /> Each additional outlet over 4 oullets x $.50 = $ __ <br /> <br /> H£AT~gRS <br /> SUSPENDED HEATER x $6.CO = $ <br /> WALL HEATER x $6.00 = $ <br /> FLOOR MOUNTED x $6.00 -- $ <br /> <br /> HEAT PUMP <br /> UNDER 3 TON x $6.50 = $ __ <br /> 3 TON AND MORE x $11.00 $__ <br /> <br />N/C <br /> <br />5. FEES <br />Al. Enter total of fees from Sec. g4 $ <br />A2. Add 5% surcharge (.05 x Al) $ <br /> Subtotal $ <br /> <br />B. Enter 25% of line A 1 for Plan Review <br /> (Al + .25). if required <br />C. Investigation Fee (if required) <br />D. Relnspection Fee ($25.~)) <br /> <br />Receipt No. <br /> <br />TOTAL AMOUNT DUE <br /> <br />$ <br />$ <br />$ <br />$ <br /> <br />MC 15-41 7/97 <br /> <br /> <br />