Laserfiche WebLink
FOR CITY VALIDATION <br />Received By: <br /> <br />Date: <br /> <br /> MARION COUNTY <br />BUILDING INSPECTION DMSION <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 />MECHANICAL PERMIT APPLICATION I <br />Please complete all Sections, I through 5 <br /> I <br /> <br />1. LOCATION OF INSTALLATION <br /> <br /> CITY ~"~ ~ ~:'~9~.~ <br /> <br /> P°.wo I-la, l'-t I-I x I <br /> CROSS ST~ET/ ~- ~ ~ ~ 0 <br /> <br /> PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT <br /> STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />CONTRACTORS BOARD <br /> O,STRAT,ON <br /> <br /> / <br />2B. FOR OWNER INSTALLATIONS <br />Propelty Owner (please prinO <br /> <br /> Mailing 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 />PERMIT NO: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />4. FEE SCHEDULE (Complete and enter total in Al below) <br />RESIDENTIAL [1~ COMMERCIAL [~ USE: <br /> NEW f'l ALTERATION [~'¢~ADDITION g'l RELOCATION <br /> ~AS ql,"%t~CTmC ~ <br /> <br />GAS BARBEQUE <br /> <br />GAS PIPI~IG <br /> <br />OTHER (as requh'ed by the Buildiag Official) <br /> <br />DWELLING PERMIT LAB~[.~ <br /> (For New Single Family Dwellings Only) <br /> <br />x $7.00 = $ <br /> <br />x $6.00 =$ <br />x $7.50 = $ <br /> <br />x 57.50 =$ <br />x $7,50 =$ <br />x 57.50 =$ <br />x $7,50 = $ <br /> <br />$2.00 ~$ <br /> $50 ~$ <br /> <br />x $6.00 = $ <br />x $6.00 =$ <br />x $6.00 =$ <br /> <br />x $6.50 = $ <br /> <br />x $6.50 = $ <br /> <br />x $4.50 =$ <br />x $4.50 =$ <br />x $4.50 = $ <br />x $3.00 = $ <br />x $3.00 =$ <br /> <br />x $7.50 =$ <br />x S3.00 =$ <br />x $30.00 =$ <br /> <br /># of Labels <br /> <br />Il _0(-~ <br /> <br />N/C <br /> <br />5. FEES <br /> A I. Enter lo~a] of fees from Sec. #4 <br /> A2. Add 5% sur~ha~e (.05 x Al) <br /> <br />B. Enter 25% of line A1 for Plan Review <br /> (Al + .25), if requlred <br />C. Investigation Fee (if required) <br />D. Reinspection Fee ($25.00) <br /> <br />Receipt No. <br /> <br />TOTAL AMOUNT DUE <br /> <br />$ <br />$ <br /> <br />MC 15-41 7/97 <br /> <br /> <br />