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Received by: [ <br />Date: J <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> 285 Church St NE · Room 132, <br /> Salem; OR 97301 <br /> <br />24 Hr Inspection L/ne: 588-,7904 <br />Office,: 588-5147 8:00 a.m. - 4:30 p.m. <br />FAX;; 588-7948 <br /> <br /> MECHANICAL PERMIT APPLICATION <br /> Please complete ail Sections, I through 5 <br /> <br />1. LOCATION OP' INSTALLATION <br /> <br /> ' ' O ...... <br />PE$1T8 A~ NON-~ANS~B~ AND ~H~ ~ WORK 18 NOT <br /> <br />~, CO--ACTOR ~LATION, ,,, O~Y ...... <br /> <br />~n~rae~r's License No~I 0~ ,, <br />ConU"~tor'~ ao~ geg. No~to~C~q ] ~ob No. <br /> <br />~. ~OR OW~ ~ST~LATION8 <br /> <br />~pe~y Own~ ¢l~aseprim) <br /> <br />M~iling Addre~ Phone <br />City/State/Zip <br /> <br /> 3. PLAN REVIEW SECTION <br /> <br />Marion County does not require a plan review. <br />:We will provide plan review service if you complete <br />Section 5B and submit two (2) sets qf plans and <br />specifications with this application. <br /> <br />MC ]3-41 <br />Rev, 12/94 <br /> <br />Issued by: <br /> <br />4. FEB SCHEDULE (Complete and enter total in Al below) <br /> <br /> RI~$IDENTIAL ~ COMMERCIAL ~ <br /> USE OF STRUCTURE: <br /> NEW [] ~LTERATION ~XDD1TIoN m ~OCATION tn <br /> GAS ~ or ELECTRIC rn <br /> No. X Fe~ ~ Sum <br />BA$1~ FE'~ $10.00 <br /> <br />FORCED AIR FURNACE <br />up to 100,000 BTU ~ $ 6.00 <br />over 100,000 BTU $ 7,00 <br /> <br />Floor Furnace $ 6,00 <br />Suspended Heater $ 6,0~ <br />Wall Heater $ 6,00 <br />FlootMounted I/eater $ 6,00 <br /> <br />HEAT PUMP <br />mad*l- 3 Ton $ 6,50 <br />3 Ton and up $11,00 .... <br /> <br />AIR CONDITIONER <br />under 3 Ton $ 6.50 <br />3 Ton and up $11.00 <br /> <br />EvaporativeCooler $ 4.50 <br /> Other $ 7,50 <br /> <br />GAS PIPING SYSTEM <br /> 1-4 outlets (per outlet) ~ <br /> 4 and up outlets (per outle0 <br /> <br />Appliance Venls not in~luded in <br />an appliance: permit <br /> <br />OTHER (as required by B~I~ O~ciaO <br /> <br />$ 2,00 C~.~ <br />$ .50 <br /> <br />$ 3.00 <br /> <br />5. FEES <br /> A I, Entsr total of f~es fiDxn See. <br /> A2. Add 5% a~har~ (,05 x Al) <br /> <br /> (A 1 * ,25), if ~qu~d <br /> C. lnveafigation Fee (ifmqui~) <br /> D. Reinspc~tion Fee ($~5.~) <br /> <br /> TOT~ ~O~ <br /> <br /> <br />