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FOR CITY VALIDATIONl <br />Received by: __ <br />Dat~: ~ <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br />COMMUNITY DEVELOPMENT CENI~R <br />285 Church St NE · Room 132 PERMIT NO: <br />Salem, OR 97301 <br /> Date: <br /> <br />24 Hr In~/t~tiofl Line: 588-7904 <br />O!ff'le~g 5811-5147 $:00a.m.-4:30p,m, <br />FAX: $85-7948 <br /> <br />MECHANICAL PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />Deacfiplion/l~ir~tiom <br /> <br />IPERMITS ARE NON-TRANSFERABLE AIqD ExPnllg l~ WORK IS NOT <br /> STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> wORK Is SUSFIgNDED FOR 180 DAYS, <br /> <br />2A. CONTRACTOR IlqSTALLATION ONLY <br /> <br />Mailing Addreaa <br /> <br />2B. FOR OW~ INSTALLATIONS <br /> <br />Signature: <br /> <br /> 3. PLAN RBVIEW SECTION <br /> Maii0~'"u~unty 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 />I specifications with ,this application. <br />MC 1541 <br /> <br />Issued by: <br /> <br />4. FBR 8CHlgDULE (Complet¢ and ent~ total in A1 below) <br /> <br /> RESIDENTIAl, [~ COMMERCIAL <br /> USE OF STRUCTURE: <br /> NEW rn ALTERATION D ADDITION m RELOCATION <br /> GAS CI or ELECTRIC [~ <br /> Ilo, X 1*~ = Sum <br />BASE FEE $10,00 <br /> <br />]FORCED AIR FURNACI~ <br />up to 100,000 BTU $ 6.00 <br />over 100,000 BTU $ 7.00 <br /> <br />FlootFuma¢¢ $ 6.00 __ <br />Suspended Heater $ 6,00 __ <br />Wall H~atex $ 6.00 __ <br />Floor Mounted Healer $ 6.00 __ <br /> <br />HEAT PUMP <br /> <br /> ~ Ton and up <br /> <br />AIR CONDiTIONItR <br /> ~der ~ Ton <br /> ~ Ton and up <br /> <br />~a~tiv~lcr <br /> <br />~mcstlc R~g~ H~d <br /> <br />T <br /> <br />$ 630 <br />$11.00 <br /> <br />$ 6.50 <br />$11.00 <br /> <br />$4,5O __ <br />$4.50 <br />$ 4.50 __ <br />$4.50 <br /> <br /> 3.00 <br /> 3.00 <br /> 7.50 <br /> 7,50 <br />~0.00 __ <br /> <br />$ 7,50 <br />$ 7,50 <br />$7.50 <br />$7,5O <br /> <br />OAS PIPINO SY$0E~M <br /> 14 oullgla (pgr outle0 <br /> 4 and up outlcta (per outle0 <br /> <br />OTHER (~s reqltir~d by Buildiog O~Jcis0 <br /> <br />$ 2.00 <br />$ ,5O <br /> <br />$ 3.0O <br /> <br />N/C <br /> <br />5. F~BS <br />Al. Enter total of fees from S~. #4 $,__ <br />A2, Add 5% sumharl~ (,05 x Al) $, <br /> Subtotal ~__ <br /> <br /> B, Enter 25% of line A 1 for Plan Review <br /> (Al + .95), if required $__ <br /> C, Investigation Fee (i f r~qui~d) $__ <br /> D. Reinspection Fee ($25.00) $__ <br /> <br /> TOTAL AMOUNT DUE $ <br /> Receipt No. <br /> <br /> <br />