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FOR OFFICE USE ONLY <br />Received by: <br />Date:_ <br /> <br />lVIARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> 285 Church St. NE - Room I32 d ~ <br /> Salem, Oregon 97301 <br /> <br />Phone 58g-5147 $:00 s~m. - 4:30 <br /> <br />Please complete all Sections, 1 through 5 <br /> <br />MECHANICAL PERMIT APPLICATION <br /> <br />1, LOCATION OFINSTALLATION <br /> <br />Cod¢.A-Pho~: S85-7904 <br />FAX: 588-7948 <br /> <br />D/rectiens <br /> <br />PERMITS ARE NON-TRANSFERABLE AND lION.REFUNDABLE AND <br />EXPIRE IF WORK IS NOT STAKT~D WITHIN 150 DAYS OF ISSUANCE <br />OS. IF WORK iS SUSP~3NDED FOR 180 DAYS. <br /> <br /> 2A, CONTRACTOR INSTALLATION ONLY <br /> <br />MailinS Address <br /> <br />,[ Job No. <br /> <br />2B, FOR OWNER INSTALLATIONS <br />PmpcRy Owner <br />Mailim8 Address Phone <br />City/State/Zip <br /> <br />Th~ installation is being made on property I own which is not intended for ~ale, <br /> <br />Owners Signature <br /> <br /> 3. PLAN REVIEW SECTION <br /> <br />We will provide plan review service if you complete Section <br />SB and submit two (2) gets of plans and specifications with <br />this applicatioo. <br /> <br />This optional plan review program does not suspend the <br />required submission ofplnns, and specifications when required <br />by the Oregon Structural Specialty Code, Chapter 53. <br /> <br />MC 15-41 <br />Rev, 8/94 <br /> <br />SITE #: Permit No. <br />Date: <br /> <br />Issued by; <br /> <br />BASE ~E $10.00 <br /> <br />Fomed Air Furrowed <br />100,000 BTU or less <br />Over I00,000 BTU <br /> <br />Floor Euraace <br />Suspended Heater <br />Wall Healer <br />Floor Mounted Unit Heater <br /> <br />Heat Pump [] / Air Couditloner [] <br /> Up to 3 Ton <br /> 3 Ton to 15 Ton <br />Evaporative Cooler <br />Exhaust System, Comm~cial <br />Hood and Exhaust, Commercial <br /> <br />Domestic Range Hood <br />Domestic Exhaust Fans <br /> add Dryer Vents <br />Ffl-e Demper <br />Wood Stove <br />Furnace Duets (Alteration, Extension) __ <br /> <br />Commercial or Industrial Incinerator <br /> <br />C. ras Water Heater (relocation <br /> or repla¢eanent) <br />Ga~ Connection: · <br /> --I~' outlet, up lo 4 <br /> --over 4, $8,00 plus ea. <br /> additional <br /> <br />T <br /> <br />For the Installation, Relocation <br /> or Replacement orca. Appliance <br /> Vent not included in an <br /> Appliance permit. <br /> <br />Other (as required by Building Official) <br /> <br /> $ 6,00 <br /> <br />-- $ 7.50 <br /> <br /> $ 6.00 <br />__ $ 6.00 <br />__ $ 6,00 <br /> $ 6.00 <br /> <br />-- $ 6.00 <br />$11.00 <br />__ $ 4.50 <br />__ $ 4,50 <br />$ 4.50 <br /> <br />__ $4.50 <br /> <br /> $ 3.00 <br />__ $ 3.00 <br /> $ 7.$0 <br /> $4.50 <br /> <br />__ $30.00 __ <br /> <br />__ $ 7.50 <br />__ $ 2.00 <br />__ $ .50 <br /> <br />__ $ 3.00 <br /> <br />5, FEES <br /> A I. E~r total of ~¢~s from Sec. #4 <br /> A2, Add 5% mrcharg¢ (.05 x A 1) <br /> <br /> SubmtaI <br /> <br /> B, Enter 25% of llne A 1 for Plan Revlcw <br /> (Al x ,25) if requlred <br /> <br />$ <br /> <br />$ <br /> <br /> <br />