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FOR CITY VALIDATION I <br />Rec~iYed by:. <br />Date: <br /> <br /> MECHANicAL PEHMIT APPMGATION <br /> P/easd complete all Sections, I through <br /> <br />MARION COUNTY BUILDING <br /> COMMUNITY DEVELOPMENT CENTER <br /> 285 Church St NE' Room 132 <br /> Salem, OR 97301 <br /> <br /> ~ Hr Insp~tio~ L~o: <br /> <br /> ~: sss-*ga <br /> <br /> RESIDE~I~ <br /> <br />1. LOCATION OF INSTALLATION <br /> <br /> STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR Id0 DAYS. <br /> <br />2A_ CONTRACTOR INSTALLATION ONLY <br /> <br /> Contra¢*x~r'a License No. i Od I J <br /> Con rac offs Board Red No. Job No, ~ 5'1 ~ '~.0-~ <br /> <br />IPERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK I$ NOT <br /> <br /> FOR OWNtlR Iiq'dTALLATIONS <br /> <br />Property Owner (pl~*~p£iat) <br /> <br /> 3. PLAN REVIEW SECTION <br />I Marion County does not require a pla~ review, <br /> We will provide plan review service if you eomplele <br /> Section 5B and submit two (2) sets of plans and <br />I peomc tt0n wire <br />mi~ application: .... <br />M~ 1.5-41 <br /> <br />USE OF STRUCTURE: <br />NEW,~.,_ALTERATION LI ADDITION El RELOCATION <br />GAS ,~t~.or ELECTRIC El <br /> No. X P~, <br /> FEE <br /> <br />FORCED AIR FURNACE <br />upto lO0,OeO BTU [ $ 6,00 <br />over 100D00 BTU $ 7,00 <br /> <br />Floor Furaac¢ $ 6,00 <br />Suspended Healer $ 6.00 <br />Wall Heater $ 6,00 <br /> <br />HEAT PUMP <br /> <br />AiR CONDITIONER under 3 Ton <br /> <br />Commercial Hood and Exhaust <br />Domestic Range Hood <br /> <br />6,50 ..... <br />11,00 ....... <br /> <br />$ 6,50 <br />$tl.00 <br /> <br />$4,50 <br />$4,50 <br />$ 4.50 <br />$4,~0 <br /> <br />$ 3.00 <br />$ <br />$7.50 <br />$ 7.50 <br />$50,00 <br /> <br />$7,30 <br />$7.50 <br /> <br />$ 7.50 <br /> <br />GAS PIPING SYSTEM <br /> 14 outlets (pet outlet) [ <br /> 4 and up o[tt~ts (per outlet) <br /> <br />OTEiZR (as requtrcd by Btttlt~tlg <br /> <br />DW£LLINO PERMIT LABEL #of Labels <br /> <br />$ 2,00 ~OO <br />$ ,50 <br /> <br />$ 3.00 <br /> <br />5. FEES <br /> A l, Enter total of l~ea from $¢¢, #4 <br /> A2, Add 5% sm'~harga (.05 ~ Al) <br /> <br />B. Enter25% of tino Al for Plan Review <br /> (Al + .25), if r~quimd <br />C. Investigation Fee (if required) <br />D. Reimpcction Fee ($~3,~) <br /> <br /> TOT~ ~O~ DU~ <br /> <br />$ <br /> <br />s_ t <br /> <br /> <br />