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FOR CITY VALIDATION <br />Reeeived by: <br />Date: <br /> <br />MARION COUNTY BUILDING INSPHCTIO~i <br /> COMMUN~Y DEVELOPMENT <br /> 285 ChurchSt ~. Room 132 <br /> Sal~, OR 97301 <br /> <br /> ~Hr In~tion L~: 58~7~ <br /> Off~ 58~5147 8:~a~.-4:30p.m. <br /> F~: 588-7948 <br /> <br /> MECHANICAL PERMIT APPLICATION <br /> Please complete all Sections, I through $ <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />PEEIvlIT~ ARE NON-TRANSFERABLE AND F.X FIRE 1F 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 /> <br /> ' - ...... t -' qTZ2t <br /> <br />Conira,tor', Lie~n, Ho. <br /> l <br /> <br />?..B. FOR OWNER I~$T~,LLATION8 <br /> <br />Property Owner (ploa~print) <br /> <br />Mailing Address Phone <br /> <br />City/StateFZip <br /> <br />Owner's Signature: <br /> <br />Agent'n Signature: <br /> <br />3. PLAN RBVIEW 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 of plans and <br />specifications with this application. <br /> <br />M~ 15-41 <br />Roy. 12/~4 <br /> <br />4. FEE 8CHEDULE (Complete and entex total in Al below) <br /> RESIDENTIAL ~l COIVI~MERCIAL t~ <br />USE OF STRUCTURE: 10~/~O J~ /c/O6t~'~-~ <br />NEW~i~ ALTERATION t2 ADDITION [2 RELOCATION <br /> GAS ~ or ELECTRIC ,~ ~ <br /> No. X Fee <br />BASE FEE <br /> <br />FORCED AIR FURNACE <br />up to 100,000 BTU L~ $ 6.00 <br />over 100,000 BTU $ 7.00 <br /> <br />Floor Furnace $ 6.00 <br />Suspended Heater $ 6.00 <br />Wall He~utcr $ 6.00 <br />Floor Mounted Heater $ 6.00 <br /> <br />HEAT PUMP <br />under 3 Ton $ 6.50 <br />3Tonand up L~ $11.00 <br />AIR CONDITIONBR <br />under 3 Ton $ 6.50 -- <br />3 Ton and up $11.00 -- <br /> <br />EvaporativeCooler $ 4.50 -- <br />and Dryer Vents $ 3.00 <br /> <br />ADDmONAL APpIlARCBS <br /> Gas Water Heater ~)// ] <br /> <br /> 4 and up oatleta (I~r outlet) -'~-.~ $ <br /> <br />$7.50 <br /> <br />$ 73O <br />$7.50 <br /> <br />N/C <br /> <br />5. FEES Al. Emer totalof fees from Sec.//4 <br /> A2. Add5% sur~harg~ (.05 x Al) <br /> <br />8ubtotml $ <br /> <br />B. Enter25% oflinoAl for Plan R~viow <br />(Al + .25), if required $ <br />C. Investigation Fca (if required) $.__ <br />D, Reinspection Fee ($25.00) $//'-'~ ~$--~ <br /> TOTAL AIdOUNT DUB <br />Receipt No. <br /> <br /> <br />