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FOR CITY VALIDATION <br />Received by: <br />Date: <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 Line: 588-7904 <br />Office: 588-514'/ 8:00 a.m. - 4:30p.m. <br />FAX: 588-'/948 <br /> <br />PERMIT NO: <br /> <br />Date: <br /> <br />Issued by: <br /> <br /> MECHANICAL PERMIT APPLICATION <br /> Please complete all Sections, I through $ <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT <br /> STARTED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSPENDED FOR 180 DAYS. <br /> <br /> 2A. CONTRACTOR INSTALLATION ONLY <br />[Contractor ~ Phone <br /> Mailing Address <br /> <br />Contractor's License No. <br /> <br />Contractor's Board Reg. No. <br /> <br />Contractor's Signature: <br /> <br />.lob No. <br /> <br />2B. FOR OWNER INSTALLATIONS <br />Property Owner (please print) <br />Mailing Address Phone <br />City/State/Zip <br />Owner's Signature: <br />Agent's Signature: <br /> <br />3. PLAN REVIRW SECTION <br /> <br />4. FEE SCHEDULE (Complete and enter total in Al below) <br /> <br /> RESIDENTIAL [] COMMERCIAL [] <br /> USE OF STRUCTURE: <br /> NEW [3 ALTERATION [3 ADDITION [3 RELOCATION <br /> <br />GAS [3 or ELECTRIC <br /> <br /> No. X Feo = Sum <br />BASE FEE $10.00 <br /> <br />FORCED AIR FURNACE J <br />up to 100,000 BTU i $ 6.00 <br />over 100,000 BTU $ 7.00 <br /> <br />Hoor Furnace $ 6.00 <br />Suspended Heater $ 6.00 <br />Wall Heater $ 6.00 <br />Floor Mounted Heater $ 6.00 <br /> <br />HEAT PUMP <br />under 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 />Commercial Exhaust System $ 4.50 <br />Commercial Hood and Exhaust $ 4.50 <br />Domestic Range Hood $ 4.50 <br />Domestic Exhaust Fans <br />and D~er Vents $ 3.00 <br />Fire Damper $ 3.00 <br />Wood Stove/Fireplace $ 7.50 <br />Furnace Ducts (Alteration/Extension) $ 7.50 <br />Commercial / Industrial Incinerator $30.00 <br /> <br />ADDITIONAL APPLIANCES <br />Gas Water Heater $ 7.50 <br />Gas Log Lighter $ 7.50 <br />Gas Barbeque $ 7.50 <br />Other $ 7.50 <br /> <br />GAS PIPING SYSTEM <br />1-4 outlets (per outlet) [ $ 2.00 <br />4 and up outlets (per outlet) $ .50 <br /> <br />Appliance Vents not included in <br />an appliance permit $ 3.00 <br /> <br />OTHER (as required by Buil&'ng Ot~ciaO <br /> <br />DWELLING PERMIT LABEL # of Labels <br /> <br />N/C <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 />5. FEES <br /> Al. Enter total of fees from Sec.//4 <br /> A2. Add 5% surcharge (.05 x Al) <br /> <br />Subtotal <br /> <br />B. Enter 25% of line A1 for Plan Review <br /> (Al + .25), if required <br />C. Investigation Fee (if required) <br />D. Reiuspection Fee ($25.00) <br /> <br />TOTAL AMOUHT DUE <br /> <br />MC 1.541 Receipt No. <br />Rev. 12/94 <br /> <br /> <br />