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MARION COUNTY BUILDING INSPI~CTION <br /> COMMUNITY DEVELOPMENT CENTER PERMIT NO; <br /> 285 Church St NE ' Room 132 <br /> Salem, OR 97301 <br /> <br />IMECHANICAL PERMiT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />LOCATION OF INSTALLATION <br /> <br />24 Hr Inspeetlon Line; 588-7904 <br />Officea 55g-5147 g;00 a.m. - 4:30 p.m. <br />FAX: 588-7948 <br /> <br />PERMITS AR~ NON-TRANSFeRABLE AND .~XPIRE ~ WORK IS NOT <br /> STARTE, D wrrItlN 180 DAYS OF ISSUANCE OR IF <br /> WO, RK IS SUSPENDED FOR 150 DAYS. <br /> <br />2A, CONTRACTOR INSTALLATION ONLY <br /> <br />M~iliag Adde~a <br /> <br />215. FOR OW~'~R I~STALLATIONS <br />Properly Owner (please primo <br /> <br />CitylSta~elZip <br /> <br />Owner's Signature: <br /> <br />Date: <br /> <br />issued by: <br /> <br />4. F~[l:l ~CH]~DUL]:i (Colnplet~ and enter tolal in Al below) <br /> <br /> RESID~I~ ~ COMMERCI~ ~ <br /> USE OF STRUCT~E: <br /> NEW ~ ALTERATION ~ ADD~ON ~ REL~ATION <br /> <br /> GAS ~ or ELECTRIC rn <br /> <br />BA~E FEE $10,00 <br /> <br />FORCED AIR FURNAC~ <br />up to 100,000 BTU ~ $ 6,00 __ <br />over 100,000 BTU $ 7,00 <br /> <br />FloorFuma¢~ ~ $ 6.00 __. <br />Suspemded Heater $ 6.00 <br />Wall Heater $ 6.00 __ <br />Fleet Mount*d Heater $ 6.00 <br /> <br />HEAT PUMP <br />under 3 Ton $ 6,50 __ <br />3 Ton and up $i 1.00 -- <br /> <br />AIR CONDITIONBR <br />under 3 Ton $ 6,50 ~ <br />3 Ton and up $11,00 .., <br /> <br />Wood Stove/Fircplaoe __Iff- $ 7.50 <br /> <br />GA8 PIP[NO 8YSTEM <br />1-4 oullcts (peroutle0 $ 2,00 __ <br />4 und up outle~ (~ outle0 $ .50 ~ <br /> <br />Appliance Ven~ ~t 1o¢I~d~d in <br />m~ appliance pe~it $ 3.~ ~ <br /> <br />OTHER (~s required by Bu/I~ O~c/~o <br />DWELLING PE~ L~L ~ of ~bels N/C <br /> <br />3. PLANKEVIEW SECTION <br /> <br />Marion County does not requlre 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 applicati0n. <br /> <br />~C 1.5.41 <br /> <br />A~,. Add 5% s~eha~ (.05 x Al) $_ <br /> Subto[al $. <br /> <br />B. ~ter 25% of line A 1 for PI~ Review <br />(Al + .25).if~qui~d $. ~ <br />C, lnv~tigalion Pro (if~qui~d) <br />D. Reimpeelion gee ($25.~) $,~ <br /> <br /> TOT~ ~Ok~ D~ <br /> <br /> <br />