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FOR CITY VALIDATION <br />Received by: <br />Dat~: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> COMMUNITY DEVELOPMENT CENTER <br /> 285 Church St NE- Room 132 PERMIT NO: t~r~'' /~/// <br /> Salem, OR 97301 <br /> Date: <br /> <br />24 Hr Inspection Li~e: 588-7904 <br />Office: 588-5147 8:00a.m. - 4:30p.m. <br />FAX: 588-7948 <br /> <br />Issued by: <br /> <br />MECHANICAL PERMIT APPLICATION <br />Please complete all Sections, I through 5 <br /> <br />1. LOCATION OF INSTALLATION <br /> <br />JobAddr~s ///~ /~./0/r' ~,0 ~'gt= <br /> <br />PERMITS ARE NON-TRANSFERABLE AND EXPIRE IF WORK IS NOT I <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 /> <br />Mailing Address <br />Contractor's Licens~ No. <br />Contractor's Board Reg. No. Job No. <br />Contractor's Signature: <br /> <br />28. FOR OWNER INSTALLATIONS <br /> <br />4. F~E SCHIRF}ULE (Complete and enter total in A1 below) <br /> <br /> RESIDENTIAL [~l COMMERCIAL [--I <br /> USE OF STRUCTURE: <br /> NEW ~1 ALTERATION {~ ADDITION [2 RELOCATION <br /> OAS Q or ELECTRIC O <br /> No. X Fee, = Sum <br />BASE FEE $10.00 <br /> <br />FORCED AIR FURNACE <br />up to 100,00~ BTU $ 6.00 <br />over 100,000 BTU $ 7.00 -- <br /> <br />Flo~rPumace $ 6.00 -- <br />Suspended Heater $ 6,00 <br />Wail Heater $ 6.00 -- <br />Floor Mounted Heater $ 6.00 <br /> <br />HEAT PUMP <br /> under 3 Ton <br /> 3 Ton and up <br /> <br />AIR CONDITIONER <br /> under 3 Ton <br /> 3 Ton and up <br /> <br />EvaporativeCeoler <br />Colmnercial Exhaust System <br />Commercial Hood and Exha~t <br />Domestic Range Hood <br /> <br />$ 6.50 -- <br />$11.00 <br /> <br />$ 6.5O <br />$11.o0 -- <br /> <br />$ 4.50 -- <br />$4.50 -- <br />$ 4.50 <br />$ 4.50 <br /> <br />$ 3.00 <br />$ 3.~0 -- <br /> <br />$ 7.50 <br />$30.00 -- <br /> <br />$7.50 <br />$ 7.50 <br />$ 7.50 <br />$ 7.50 -- <br /> <br />GAS PIPING SYSTEM <br /> 1~ outlets (per outlet) <br /> 4 and up outlets (per eotlet) <br /> <br />Appliance Vents not included M <br />~ appliance permit <br /> <br />OTHER (as required by B~il~g Official) <br /> <br />DWELLING PERMIT LABEL # of Labels <br /> <br />$ 2,00 <br />$ .50 <br /> <br />$ 3.00 __ <br /> <br />N/¢ <br /> <br />3. PLANRBVIBW SECTION <br /> <br />Marion County does not require a plan review. <br />We will provide plan review service if you complete <br />Section 58 and submit two (2) sets of plans and <br />specifications with this application. <br /> <br />MC 1541 <br />R~v. 12~24 <br /> <br />5. FEES <br /> A 1. Enter tutai of fees flora Sec. 84 <br /> A2. Add 5% gurcharge (.05 x Al) <br /> Subtotal <br /> <br /> B. Enter 25% of line Al for plan Review <br /> (Al + .25), if required <br /> ¢. Investigation Fee (if required) <br /> D. Reitmpection Fee ($25.00) <br /> <br /> TOTAL AMOUNT DUB <br /> Receipt No. ~ <br /> <br /> <br />