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FOR CITY VALIDATION <br />Received by: <br />Date: <br /> <br />MARION COUNTY BUILDING INSPECTION <br /> <br />COMMUNITY DEVELOPMENT CENTER <br />285 Church St NE. Room 132 <br /> Salem, OR 97301 <br /> <br /> 24 hr. Inspection Line 373-4427 <br />Office: Phone ~8~5147 8:00am - 4:30pm <br />FAX: S88-7948 <br /> <br />MECHANICAL PERMff 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 /> STARTLED WITHIN 180 DAYS OF ISSUANCE OR IF <br /> WORK IS SUSIrEIqDED FOR 180 DAYS. <br /> <br />2A. CONTRACTOR INSTALLATION ONLY <br /> <br />:lB. FOR OWNI~R IH~TALLATIONS <br /> <br />Property Owner (ple~pri~) <br />Mnillng Address Phcoe <br />City/S~ate/Zip <br />Owner's Signature: <br />Agent's Signature: <br /> <br />PERMIT NO: <br /> <br />Date: <br /> <br />Issued by: <br /> <br />4. l:tE~l ,c-~CI'I]~DlJl-lq (Complete and enter total in Al below) ~.~ <br /> <br /> RE~DENTIAL [-I COMMERCIAL [-I ,~ <br /> <br /> U~i~ OF STRUCTURB: r~ <br /> NEW n ALTERATION n ADDITION n RELOCATION n <br /> <br /> GAS (3 or ELECTRIC m <br /> No. X Pe~ = ,qum <br />BASE FEB $10.00 <br /> <br />e <br /> <br />FORCED AIR FURNACE <br />up to 100,000 BTU $ 6.00 <br />over 100,000 BTU $ 7.00 <br /> <br />FloorFumace $ 6.00 -- <br />Suspended l-l~aler $ 6.00 <br />Wall H~ter $ 6.00 <br />Floor Mounted Heater $ 6.00 <br /> <br /> under 3 Ton $ 6,50 -- <br /> 3 Ton and up $11,00 <br /> <br />EvaporativeCooler $ 4.50 <br /> <br />Domestic Range Houd $ 4.50 <br />and Dryer Vents $ 3.00 <br /> <br />Furnace Ducts (Alte~ation/Extemion) $ 7,50 -- <br />Commercial / Industrial Incinerator $30.00 <br /> <br />Oas Log Ligh~r $ 7.50 __ <br />O~ Barb~qu~ $ 7.50 <br />Othe~ $ 7.50 -- <br /> <br />(]lAS PIPINO 8YSTI~M 14 outlets (per outlet) <br /> 4 and up outlets (per eutle0 <br /> <br />Appliance Venls not included in <br />m appliance permit <br /> <br />OTHER (as r~quired by Bidldi~ Official) <br /> <br />DWELLINO PERMIT LABB~ #oft.abels <br /> <br />$ 3.00 -- <br /> <br />N/C <br /> <br />:3. PLANR~VIH. W 8BCTION <br /> <br />Madon County doe~ not require a plan review. <br />We will provide plan review service if you complete <br />Section 5B and submit two (2) ~e~ of plans and <br />specifications with this application. <br /> <br />MC 1541 <br /> <br />Al. Enter total of fees from Sec. ~ <br />A2. Add 5% surcharge (.05 x Al) <br /> $.~ <br /> <br />B. ~t~ 25~ of l~e A l f~ PI~ Renew <br /> (Al + ~), if ~qu~ $.~ <br />C. ~v~s~ga~n ~ (if ~ui~) <br />D. Re~t~n ~o (~.~) <br /> <br /> TOT~ ~O~ <br />~ceipt No. <br /> <br /> <br />