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FOR CITY VALIDATION <br />Received by:. <br />DatE: <br /> <br />MARION COUNTY BUILDING,INSPECTIO~ <br /> 285 Church St NE Room Salem, OR 97301 <br /> <br />MECHANICAL PERMIT APPLICATION <br />Plea$o complote all Sections, 1 through 5 <br /> <br />1_ LOCATION OF I~STALLATION <br /> <br />[ PI~RMI'fS AR/~ N ON -TRAlq SirRA BLI~ AHD EX~IRE IF WORK I~ HOT <br /> $TAR~ ~HIN 1 ~ DAYS OF ISSU~ OR IF <br /> WO~ IS ~USP~D~ FOR tS0 DAYS, <br /> <br /> COntra~tor'a Boa~ R~g, ~o ~ ~ ~b No. <br /> <br /> FOR OW~R <br /> <br /> Pm~ay Owner Olon~ priaO <br /> <br />' Mailing Add~st~ [ Phoo* <br />CRy/Stateff~p <br /> <br />IMarion C';unty d0es'not require a plan re~iew. '" <br />We wilt provide plan review service if you complete <br />Section 5B and submit two (2) sets of plans and <br />specifications with this,,, application~ <br />MC 13.41 <br /> <br />4. ]~EE SCI'I]~DI{~E (Complete and Cmer mini ia A 1 below) <br /> RESIDE~I&L '~ COMMBRCi~ <br /> USE OF STRUCTURE: <br /> ALTERATION Q ADDITION _~OCATION <br /> NEW <br /> GAS ~ or ~ECTRIC ~ <br /> <br />B~E FEE <br /> <br />PORCI[D AIR FURNACE <br />up to 100,000 BTU -- $ 6.00 <br />oYer lOO,O00 BTU $ 7.00 <br /> <br />FI0ot Fumuc~ <br />Su~pmdcd H~at*r <br />Hoo/Momlled H~tcr $ 6.~ <br /> <br />HgAT PUMP <br />under 3 Ton <br />~ Ton and up $ I I.~ <br /> <br />~R CO~ITIONER <br />~dgr 3 Ton $ 6.50 <br />3 Ton and up <br /> <br /> EvaporalivcCcmler <br /> Commercial E~atls{ System $ 4.~ <br /> <br />~)mcsti¢ Rimg~ Rot~ <br /> <br /> 14 oud~u (p,r oml¢0 <br /> <br />OTHER Os ~uquimd by But'l~t$, O~ciaO <br /> <br />A2, Add 5% su~harge (.05 x Al) <br /> <br />B, Entel25% of line Al [hr Plan Review <br /> (A 1 + .25), if required <br />C. Investigation Fe~ (ifrgquired) <br />D. R¢inap¢¢tion P~o ($25,00) <br /> <br /> TOTAL AMOUNT DUE <br /> <br /> <br />