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~FI3R CITY VALIDATION <br />/Reeelved 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-?904 <br />OIYlce: 588-5147 8:00 a.m. - 4:30 p.m. <br />FAX: 588-7948 <br /> <br />MECHANICAL PERMIT APPLICATION <br />Please complete all Sections, I through 5 <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 /> <br /> liB. FOR OWNllR INSTALLATIONS <br /> <br /> Fwperty Owner (ple~seprint) <br /> lviailin~ Addreaa / Phone <br /> City/State/7_Y~p <br /> <br /> 3. PLANRBVIEW SECTION <br /> <br /> Marion County does not require a plan review. <br /> We will provide plan review service if you complete <br />I Section 5B and submit two (2) sets of plans and <br /> specifications with this application. <br /> <br />MC 15-41 <br /> <br />PERMIT NO: <br /> <br />Issued by: <br /> <br />4. FEll SCttBDUI~ (Complete and ente~ ~otal in Al below) <br /> RESIDENTIAL~ COMMERCIAL fi] <br /> USE OF STRUCTURE: <br /> NEW El ALTERATION El ADDITION [~ RELOCATION <br /> <br />GAS~ or ELECTRIC <br />BASE FEE <br /> <br />PORCED AIR FURNACE <br />ap to 100,000 BTU $ fi.a) -- <br />over 1(113,000 BTU $ 7.00 <br /> <br />Floor Furnace $ 6.00 <br />Suspended Heater $ 6.00 <br />Wall Heater $ 6.00 <br />Fl~or Mounled Heat*r $ 6,00 <br /> <br />HEAT pUMP <br />under 3 Ton $ 6,50 <br />3 Ton andup SILO0 <br /> <br />AIR CONDITIONER <br />under 3 Ton $ 6.50 <br />3 Ton and up $11,00 <br /> <br />Ev~por~tiveCool~r $ 4.50 <br />Commercial Exhaust System $ 4.50 <br />Commercial Hood mid Exhaust $ 4.50 <br />Domestic Range Heod $ 4.50 <br />Domestic Exhaust Fans <br />and D~r Veins $ 3.00 <br />Fire Damper <br /> <br />7.50 -- <br /> <br />OAS PlPliV~ SYSTEM <br /> 14 outlets (per outlet) <br /> 4 and up outlets (per outlet) <br /> <br />5. Fr~S <br />A I. Enter lotal of fe~ from See.//4 $__ <br />A2. Add 5% sta'eberge (.05 x Al) $ <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. Roimpectinn Fee ($25.00) <br /> <br /> <br />