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FOR CITY VALIDATION <br />Received by: <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTBR PERMIT NO: <br /> 285 Church St NE · Room 132 <br /> Salem, OR 97301 <br /> <br /> MECHANICAL PERMIT APPLICATION <br /> Please complete all Sections, I through 5 <br /> <br />L LOCATION OF INSTALLATION <br /> <br />Da[e- <br /> <br />Issued by: <br /> <br />24 Hr Insp~tion Lhae: 588-7904 <br />Office: 588-5147 g:~a.m.-4:30p.m. <br />F~: 58~7948 <br /> I i i ill II I Illl <br /> <br /> 4. FE~ SC~ (Complete and ~t~ ~1 ~ Al below) <br /> <br /> ~SIDE~I~ ~ COMMBRCI~ ~ <br /> U~ OF ~RUCT~ <br /> N~ ~ ~ON O ~DITION ~ ~OCA~ON D <br /> G~ O or ~C~IC O <br /> <br /> B~ F~ $10.~ <br /> <br />~ AP, I/NON-TRANSFERABLE AND IgXPIRB IF WORK IS NOT <br /> I <br /> STARTED VglTI-nN 180 DAYS OF iSSUANC~ OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br /> CONTRACTOR INSTALLATION ONLY <br /> <br />Mailin~Addr~s ~cP~'~, .~/~-~/~ ~/'- <br /> <br /> FOR OWNER. ]~T~TALLATIONS <br /> <br />~op~rty Owner (ple~,~pr/at) <br /> <br />Mailing Acldt~s9 Phone <br />CitT/Stam/Zip <br />Owner's Signat~: <br /> <br />FORCBD AIR FURNACE <br />up to 10~000 BTU ~ $ 6.00 <br />ov~t 1®,000 BTU $ 7,00 <br /> <br />~oorFumacc $ 6,00 __ <br />Suzpcnded Heater S §,00 __ <br />W~II Hc~ter $ 6.00 <br />FloorMounted He~r $ 6.00 __ <br /> <br />ItEAT PIIMP <br />und~ 3 Ton $ 6,!10 <br />3 Ton and up $II,00 <br /> <br />AIR CONDITIONI~ <br />under S Ton $ 6.50 <br />3 Ton and up SI1.00 <br /> <br />£vapotaliveCoolcr ~ 4,~0 <br />Commercial Exhaust System $ 4,~0 <br />~mmetaial H~od and E~dUlUS~ $ 4.~0 <br />Domc~tie Range Hood $ 4,~0 <br />Dcmc~tle B,~aust <br />and llkycr Vents $ 3.00 <br />Fire Damper $ 3.00 __ <br />Wood S~ovedFircplaee $ ?,50 __ <br />Fum~e D~cts (Al~ation/Extmsion) $ 7.$0 <br />Conu~m~ial ! IndtmU~al Incinerator <br /> <br />ADDITIONAL APPLIANCES <br />Ga~ Water Heater $ 7.50 <br />Gas L~g Lighter $ 7,~ <br /> <br /> $ 7,~ <br /> <br /> OAS PIPIN(] SY~I~aM <br /> lag outlets (per ou~le0 $ <br /> 4 and up o~ (~ oufl~0 $ .50 <br /> <br /> m appli~cc pc~h $ 3 <br /> O~ER (as mqui~d by Buil~ <br /> D~NG <br /> <br />5. <br /> Al. ~r ~ml of fees from S~, ~4 $,~ <br /> <br /> 3. PLANREVIEW SECTION <br />IMarion Cotmtydoes not require a pl~ revie'~. <br /> We will provide pl~ review se~ice if you comple~ <br /> S~on 5B and ~ubm~t two (2) s. ets of plans and <br /> specifications wi~ ~s applicaUon. <br /> <br />N/C <br /> <br />B, Eater 25% of linc A I for Plan Review <br />(Al + .25), if r~quited $,__ <br />C- Invesligation Fee (if required) <br />D, Reinspection Fee ($25.00) <br /> <br />Receipt ,N~.,, TOTAL A~IOUNT DUE ~,~,, ,. ~-~ <br /> <br /> <br />