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FOR CITY VALIDATION <br />Received by: <br />Date: <br /> <br />MARION <br /> COUNTY <br /> BUILDING <br /> INSPECTION <br /> q q I <br /> COMMUNITY DEVELOPMENT CENTER PERMff NO: <br /> <br />285 Church St NE · Room 132 <br />Salem, OR 97301 <br /> <br />24 Hr Inspection Line: 588-7904 <br />Ofl'w~: 588-514'/ 8:00a.m.-4:30p.m. <br />FAX: 588-'7948 <br /> <br />Dato: <br /> <br />Issued by:. <br /> <br /> MECHANICAL PERMff APPLICATION <br /> Please complete all Sections, I through $ <br /> <br />1. LOCATION OF I~STALLATION <br /> <br />- <br /> <br />[PEllETS AND EXPIRE IF WORK IS NOT <br /> ARE <br /> NON-TRANSFERABLE <br /> <br /> 2A. CONTRACTOR INSTALLATION ONLY <br /> <br /> Contractor's Licmnse No. <br /> <br />liB. FOR OWNILR INSTALLATIONS <br />Property Owner (plea~e pdm) <br />Mailing Address Phone <br /> <br />CRy/Stnte/Zip <br /> <br />Owner's Signattae: <br /> <br />Agent's Si~nntm-e: <br /> <br />4. FBB SCHEDULE (Comple~ and emer total in A1 below) <br /> <br /> RESIDENTIAL f-I COMMERCIAL [~ <br /> USB OF STRUCTURE: <br /> NEW UI ALTERATION ~ ADDITION r~ RELOCATION <br /> GAS 0 or ELECTRIC I~ <br /> No. X F~ ,~ SUm <br />BASE FEE $10.60 <br /> <br />FORCED AIR FURNACE <br />up Io 100,000 BTU i~ $ 6.00 -- <br />over 100,000 BTU $ 7.00 <br /> <br />Floor Furnace $ 6.00 <br />Suspended Heater $ 6.00 <br />Wall Heater $ 6.00 <br />Floor Motmted Heater $ 6.00 <br /> <br />HEAT PUMP <br /> under 3 Ton <br /> 3 Ton and up <br /> <br />AIR COI'O)ITIOI~R <br /> under 3 Ton <br /> 3 Ton and up <br /> <br />EvnporativeCooler <br /> <br />$ 6.50 -- <br />SILO0 <br /> <br />$ 6.50 <br />$11.00 -- <br /> <br />$4,50 -- <br />$4,50 <br />$4.50 <br />$4.50 -- <br /> <br />$ 3.00 -- <br />$ 3.oo __ <br />$7,50 -- <br />$7.50 -- <br />$30.00 -- <br /> <br />ADDITIONAL APPLIANCES <br /> <br /> Gas Log Lighter <br /> Gss Barbeque <br /> <br />$7.50 <br />$7.50 <br />$7.50 -- <br />$7.50 -- <br /> <br />OAS PIPINO SYSTEM <br /> 1-4 outlets (p~r outlet) <br /> 4 and up outlets (per outlet) <br /> <br />Appliance Vents not included in <br />an appliance p4mnit <br /> <br />OTHER (~s cequired by Buil~ Ol~aial) <br /> <br />DWELLIIqO PERMIT LABEL # of Labels <br /> <br />$ 30 __ <br /> <br />$ 3.00 <br /> <br />N/C <br /> <br />3. PLAN RBVIBW 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 />1541 <br />12/94 <br /> <br />5. FEES <br /> <br />Subtotal <br /> <br />B. En~r 25% of line Al for Plan Review <br />(Al + .25), if required $.__ <br />C. lnv~tigation Fee (if r~luirod) $.__ <br />D. Reinspeetion Fee ($25,00) $ <br /> <br /> TOTAL AMOUNT DUE $.~.~ <br />Receipt No. <br /> <br /> <br />