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FOR CITY USE ONLy <br />Received By: Da~e: <br />Zoning By: City: <br />Reoeipt #: Amount: $_ <br /> <br />I MECHANICAL PERMIT APPLICATION <br /> Please complet~ all Sections, I through $ I <br /> <br />1. LOCATION OF INSTALLATION <br />Parcel ID: <br /> <br /> Tt 't <br />Phone: ~7~7-- ~'~ q~:~ ~- <br />Cross Street/Directions: <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK <br />IS NOT STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br />WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACYOR INFORMATION -- PLEASE INDICATE <br />WHO IS DOING THE WORK <br /> <br />Contractor: ~ <br /> <br />Mailing Address: <br /> <br />77 - <br /> <br />Registration NO.: <br /> <br />2B. FOR OWNER INSTALLATION <br /> <br /> Proper~y Owner: (p/ease print) <br /> <br />Mailing Address: <br /> <br /> City: State: Zip: <br /> Phone: Fax: <br /> <br />I am the PROPERTY OWNER and own, reside in, or will reside in <br />the completed structure and will be my own general contractor 1 <br />understand that I mu~t register as a construction contractor if the <br />structure is sold or offered for sale before or upon completion, lf l <br />hire subcontractors, I will hire only subcontractors registered with <br />the Construction Contractors Boar& If I change my mind and do <br />hire a general contractor who is registered with the Construction <br />Contractors Board, I will immediately notify Marion County of the <br /> <br />Owner's Signatme: <br /> <br /> Agent's Signature: <br /> <br />3. PLAN REVIEW SECTION <br /> <br />Marion County does not require a plan review. We will pwvide plan I <br />review service if you complete Section 5B and submit two (2) sets of <br />plans and specifications with this app icat on. <br /> <br />MC 1541 Rev 9/98 <br /> <br />MARION COUNTY BUILDING INSPECTION <br />COMMUNITY DEVELOPMENT CENTER <br />3150 Lancaster Dr. NE - Suite C, Salem, Oregon 97305 <br />8:00am - 4:30pm <br /> 24 HR Inspection Line 373-4427 FAX 588-7948 <br /> <br />4. FEE SCHEDULE (emnplete and enter total in Al) <br /> <br />(~"ff. F31DENTIAL ( )COMMERCIAL (~GAS ( )ELECTRIC <br />( ) NEW ( ) ADDmON ( ) ALTERATION <br />( ) RELOCATION ( ) REPLACEMENT <br /> <br /> lhlrnat~ (inelud~ duets / vent~) <br /> Forced Air up to 100,000 BTU <br /> For~d Air over 100,000 BTU <br /> <br />~ Fireplace / Insesl ~_ ,~0 <br /> <br /> G~s Barbeque <br /> <br /> One~woFamilyDwd~gFe~. Squ~reFeet: -- <br /> <br />OTY <br /> <br />$12.00 = $ -- <br />$15.00 = $ -- <br />$12.00 -- $ -- <br />$15.00 = $ -- <br /> <br />$12.00 = $ -- <br />$15.00 = $ <br /> <br />$15.00--$__ <br />$15.00=$__ <br /> <br />$12.00--$__ <br />$12.00=$__ <br />$12.00=$__ <br /> <br />$12.00 = $ __ <br />$22.00 = $ __ <br /> <br />$15.00 = $ -- <br />$22,00 = $ -- <br />$9.00=$__ <br /> <br /> $9,00=$__ <br /> $9.00=$__ <br /> $9.00=$__ <br /> $6.00=$__ <br /> $6.00=$__ <br /> <br /> $6.00=$__ <br /> <br />$15.00=$__ <br />$6.00=$__ <br /> <br /> $ .04 = $__ <br /> <br />5. FEES - <br />BASE FEE Assessed on ALL APPLICATIONS: $ l' 25.00 <br /> <br /> SUBTOTAL <br /> <br />B. En~ 30% of line Al for Plan Review $ -- <br />C. Investigation Fee (ffrequir~d) $ -- <br />D. Reinspeetion Fee ($50,00) $ -- <br />E. Additional Plan Review ($62.50/hr, <br />minimum one-half hour) $ -- <br />F. Inspection fer which no fee is spegificaily indicated, ~tV <br />($62.50/hr. minimum one hour) $ __ <br />G. inspection Outside Normal Business Hours. <br />($62.50/hr, minimum two hours) $ -- <br />H. Seismic Fee (,01% x Al)) $ -- <br /> <br />TOTAL AMOUNT DUE <br /> <br /> <br />