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/'~OR CITY VALIDATION <br /> Received by: <br /> Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br />COMMUNITY DEYELOPMENT CENTauR <br />285 Church St NE · Room 132 <br /> Salem, OR 97301 <br /> <br />IMECHANICAL PERMIT APPLICATION <br /> Please complete ~1 Sections, I through 5 <br /> <br />i, LOCATION OP i~STALL~TION <br /> <br />¢%4 ? / ) ..... / <br /> <br />PERMIT NO: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />24 Hr Inspeation Line: 588-7904 <br />Office~ 588-5147 8:00 a.m. - 4;30 p.m. <br />FAX: 588-7941/ <br /> <br /> 4. ~]~ SCH~DDL~ (Complete and ent~ total ia Al below) <br /> <br /> RESlD~I~ ~ COMMERCI~ <br /> U~E OP STRUCT~: <br /> NEW ~ AL~ATION ~ ADD~ON ~OCATION <br /> GAS~ or ~ECTRIC ~ <br /> <br /> BASE F~ <br /> <br />PERMITS ARE NON-TRANS~BL~ AND EXPIRE IF WORK IS NOT <br /> STARTJ~) WITHIN 130 DAYS OF iSSUANC~ OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR llXISTALLATION ONLY <br />Contractor I Phone <br /> <br />Mailil~g Add.ss <br /> <br />C,~,~aotot's Lic~se No. <br /> <br />2B. FOR OWNER IlqSTALLATION$ <br /> <br />Pwperty Owner (please print) <br /> <br /> 3. PLANRBVIBW 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 /> specifications with this application. <br /> <br /> IZ~ LY,4! <br />Re~, 124~1 <br /> <br />FORCED AiR FURNACE <br />up to 100,000 BTU $ 6.00 <br />over 100,000 BTU / ~ ~.~ 7.0~ <br /> <br />S~spend~d Heate/~ <br />Wall ~eatar <br /> <br />HEAT pUMP <br />under 3 Ton , $ 6,50 <br />3 Ton and up ..... $ I 1.00 -- <br /> <br />AIR CONDITIONER <br />under 3 Ton $ 650 -- <br />3 Ton and up ~ $11.00 __ <br /> <br />EvaporafiveCoolcr $ 4.50 -- <br />Commercial Exhaust System $ 4,$0 <br />Commercial Hood sad Exhaust $ 4.50 __ <br />Domestic Range, Hood $ 4,50 <br /> <br /> $ <br /> 3,00 <br /> $ ZOO <br />Wood Stove/Fireplace ~ $ 7.50 <br />Furnace Durra (Alt ¢rstion/Ext caslon) $ 7.50 <br />Commercial / htdustdal Incinerator ~ $30,00 __ <br /> <br />ADDITIONAL APPLIANCE/; <br />O,~ Water [-[oa~et $ 7.50 <br />Gas Log Lighter $ 7.50 <br />Oas Barbeqve ~ $ 7.50 <br />Other $ 7.50 <br /> <br />OA~ PIPIN~I <br />14 outl~t~ (per earle0 <br />4 and up outlets (par ouUa0 $ .50 <br /> <br />Appliance Venl$ not include/I in <br />an appliar,~¢ permit $ 3,00 <br /> <br />OTHER (as required by BM/dog Othello <br /> <br />DWELLING PERMIT LABEL # of Labels <br /> <br />5. FF:,ES <br /> <br /> A~, Add 5% surcharge 605 x Al) <br /> <br />Subtotal <br /> <br />B, Eater 25% of litle Al for Plan P.~vi~w <br /> (Al + ,2,5), if r~quir~d <br />C. Investigation Fe~ (if required) <br />D, Reixlspection Fee (~25.00) <br /> <br />Receipt No. __ <br /> <br />TOTAL AMOUNT DUE ,~.1.~ <br /> <br /> <br />