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 3734427 <br />Office: phone 558-5147 8:00am - 4:30pm <br />FAX 58~7948 <br /> <br />Date: <br /> <br />Issued by: <br /> <br />MECHANICAL PERMIT APPLICATION <br />Please complete all Sections, 1 through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> CITY ~/~/~4~/~= <br /> CROSS S~ETt <br /> DIgTIONS <br /> <br />PROJECT DESCRIPTION <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK 1S 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 />2B. FOR OWNER INSTALLATIONS <br /> <br />Prop~ty Owner (please prinO <br /> <br />Mailing Address <br /> <br />City, SI,ate, 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 />J specifications with Wis application. <br /> <br />4. FEE SCHEDULE (Complete and entar total in A1 below) <br />RESIDENTIAL ~}' COMMERCIAL f'l USE: <br /> <br /> NEW I'1 ALTERATION [~ <br /> <br />FURNACE <br /> <br />FORCED AIR UP TO 100,000 BTU <br />FORCED AIR OVER 100,000 BTU <br /> <br />FLOOR FUP-NACE <br />DUCTS (ALTBRATION/EXTENSION) <br /> <br />GAS LOG LIGHTER <br /> <br />SUSPENDED HEATER <br />WALL HEATER <br />FLOOR MOUNI~D <br /> <br />UNDER 3 TON <br />3 TON AND MORE <br /> <br />AIR CONDITIONER <br /> <br />EVAPORATIVE COOLER <br /> <br />COML. EXHAUST SYSTEM <br />COML. HOOD & EXHAUST <br /> <br />DOMESTIC EXHAUST FANS <br />DOMESTIC DRYER VENTS <br /> <br />WOODSTOVE / FIILEpLACE <br /> <br />COML./INDUSTRIAL INCINERATOR <br /> <br />ADDITION f'l RELOOATION ~ <br />ELECTRIC fl <br /> <br /> OTY <br /> \ ~ s~.oo =$ (o oo <br /> x $7.00 =$ <br /> <br />x $~.00 =$ <br />x S7.~0 = $ <br />x $730 =$ <br />x $7.~0 =$ <br />x $750 =$ <br /> <br />x $2.00 <br />x S.50 <br /> <br />x $6,00 =$ <br />x ~.00 =S <br />x $6.00 =$ <br /> <br />x $6.50 <br />x $4.50 <br /> <br />x $4.50 = $ <br />x $4.$0 =$ <br />x $4.50 =$ <br />x$3.00 =$ ,~,oT <br />x $S.Igl = $ <br /> <br />x $3.00 = $ <br /> <br />x $7.50 = $ <br />x $~.00 =$ <br />x $30.00 = $ <br /> <br />5. FEES <br /> A I, Enter total of f¢~ from ~c, #4 <br /> A2. Add 5% surchar~ (.05 x Al) <br /> <br />B. £nt~r 25% of line A1 for Plan R~4ew <br /> (Al + .25), if required <br />C, Investigation Fee 0f required) <br />D. geinap~ction Fee ($25.0~) <br /> <br />Receipt No. -- <br /> <br />Subtotal <br /> <br />TOTAL A/vlOITNT DUE <br /> <br />MC 15-41 7/97 <br /> <br /> <br />